Anesthesia/Surgery Consent Form

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Anesthesia/Surgery Consent Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pets before your visit.

You may use the PDF version by clicking the DOWNLOAD FORM button and completing the printed form by hand. Please bring the completed PDF form for your pet’s first appointment.

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PRE-ANESTHETIC TESTING CONSENT

Like you, our greatest concern is the well-being of your pet. Your pet is scheduled for anesthesia and/or surgery. Before putting your pet under anesthesia, we will perform a full physical examination. However, we recommend a pre-anesthetic blood profile to be performed in order that we may maximize patient safety and alert the doctor to the presence of dehydration, diabetes and/or kidney or liver disease which could complicate the procedure. These conditions may not be detected unless a pre-anesthetic profile is performed. These tests may be useful later to develop faster, more accurate diagnoses and treatments in the event that your pet's health changes. *

Please complete the bloodwork recommended prior to surgery on my pet.
I have elected to refuse the recommended pre-anesthetic bloodwork at this time and request that you proceed with anesthesia.

DENTAL CARE CONSENT *

Not applicable for this visit
I have been informed that my pet is in need of preventive or therapeutic dental care and consent to the appropriate procedures described to me by staff veterinarians at Aumsville Animal Clinic, LLC. These procedures include but are not limited to the following: 1) dental prophylaxes (routine teeth cleaning and polishing) and 2) extractions.
I have been informed that examinations under anesthesia often reveal abnormally loose teeth that fall out or should be extracted to prevent oral discomfort and ongoing infection of surrounding bone. I also have been informed that the loss or removal of one or more unhealthy canine teeth occasionally allows for an awkward protrusion of the tongue to one side or the other. Nevertheless, all questions and concerns I have about the recommended dental procedures have been answered to my satisfaction.

ADDITIONAL OPTIONS/SERVICES *

Remove Retained Baby Teeth: Occasionally puppies and kittens will not lose their baby teeth on schedule, which results in potential dental problems. We routinely extract these unwanted teeth while the pet is anesthetized. There will be an additional fee for removal of retained baby teeth.
Complimentary Nail Trim

I understand that some risk always exists with anesthesia and/or surgery, including death, and that I am encouraged to discuss any concerns that I have about those risks with the attending veterinarian before the procedure is initiated. Should some unexpected life-saving emergency care be required, the hospital staff has my permission to provide basic life support treatment until the attending veterinarian is able to contact me. I agree to pay for such care. I have read and understand this consent form, and I agree to pay for services rendered at the time my pet is discharged or when service is otherwise completed.

I hereby authorize Aumsville Animal Clinic, LLC and its designated associates to perform the above approved procedure(s). In addition, in the event that emergency treatment is required and I cannot be reached, I agree to any necessary diagnostic testing, treatment, or surgical procedures which are required.

Owner or Agent: *

Email: *

Signature *

Date:

Message

We strive to keep a hospital free of external parasites (fleas/ticks). If your pet has fleas or ticks, we will treat your pet at an additional charge.

Anesthesia/Surgery Consent Form

Anesthesia/Surgery Consent Form

PRE-ANESTHETIC TESTING CONSENT

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