Anesthesia Consent Form

Pet Name:*

As the owner,I understand that during the performance of the procedure(s) or operation(s), unforeseen conditions or problems may become evident that necessitate an extension of the foregoing procedure(s) or operation(s). Therefore, I hereby consent to and authorize the performance of such procedure(s) or operation(s) as are necessary 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 personnel will be employed as deemed appropriate by the veterinarian. I have been advised about the nature of the procedure(s) or operation(s) and the risks involved. I realize that results cannot be guaranteed.

Please select all that you agree to:*

Food has been withheld since 9:00 PM last night and water has been withheld since 7:00 AM today.

I understand that my pet may have its leg shaved so that a catheter can be set so that fluids may be given during the anesthetic procedure. This keeps the blood pressure up and blood flowing to the vital organs, replenishes fluids, and also provides an injection port for emergency drugs should they be needed.

For the safety of all our pets as well as our personnel, all pets must be current on rabies vaccinations and dogs must be up to date on Bordatella (“kennel cough”) vaccinations. If they are not, these will be administered while they are hospitalized.

To your knowledge, has your pet ever had any seizures or convulsions?*

Yes

No

Other than heartworm and/or flea preventative, is your pet currently on any medication?*

Yes

No

If yes, please list the medications and how much/how often it is given.

Pre-Anesthetic Blood Testing & EKG Consent
Our greatest concern is the well-being of your pet. A pre-anesthetic blood profile and EKG are needed to evaluate health issues that could increase anesthetic risks and alert the doctor to the presence of dehydration, anemia, infection, diabetes, and/or heart/kidney/liver disease that could complicate the procedure. In addition to assessing anesthetic risks, these tests will also serve as a baseline for future evaluations. The cost for the complete blood count, blood chemistry profile, and EKG is $197.50.*

I accept the pre-anesthetic blood work and EKG required by the veterinarian.