Surgical Consent Form

Surgical Consent Form

Owner’s Name: ______Animal: ______

Address: ______Species: ______

______Breed: ______

Account Number: ______Sex: ______

I am the owner or agent for the owner of the above-described animal and have the authority to execute this consent.

I hereby consent and authorize the performance of the following procedure(s) or operation(s).

______

I understand that during the performance of the foregoing procedure(s) or operation(s), conditions may be revealed that necessitate an extension of the foregoing procedure(s) or operation(s) or different procedure(s) or operation(s) than those set forth above. Therefore, I hereby consent to and authorize the performance of such procedure(s) or operation(s) as are necessary and desirable in the exercise of the veterinarian’s professional judgment.

I also authorize the use of appropriate anesthetics, and other medications, and I understand that hospital support personnel will be employed as deemed necessary by the veterinarian.

I have been advised as to the nature of the procedure(s) or operation(s) and the risks involved. I realize that results cannot be guaranteed.

I have read and understand this authorization and consent.

______

DateSignature of Owner/AgentWitness to Signature

Pre-Anesthetic Blood Testing

Your pet is with us today for a procedure that will require anesthesia. As part of our commitment to provide the safest care for your pet that we can during its visit, we will perform a complete physical examination prior to anesthesia.

The successful use of anesthetics always depends on the normal function of the vital organs (kidneys, liver, heart). Proper liver and kidney function are imperative for your pet to metabolize the anesthetic agents. The liver must change the anesthetic into new chemical compounds, which the kidneys will then excrete into the urine. Failure of either of these functions may lead to prolonged anesthetic recovery and possibly, in extreme instances, death. It is for this reason that we strongly recommend a pre-anesthetic blood screen be performed. Abnormalities in liver or kidney functions may preclude the surgery altogether or more commonly allow the veterinarian to change the amount or type of anesthetic before proceeding with the procedure.

Our laboratory is fully equipped and staffed to perform these important blood tests. Results will be immediately available to be examined before anesthesia. Please indicate at the bottom of the anesthesia consent form whether you wish for the pre-anesthetic blood screen to be performed.

If your pet is older or had any other pre-existing medical conditions, further testing may be advisable. Please ask the veterinarian for more information if these conditions apply.

Accept ______Decline ______