Surgical Anesthetic Consent Form

AUTHORIZATION: I understand that there is always a risk associated with any anesthetic procedure, even in apparently healthy animals, and have discussed my concerns with the veterinarian. The risk increases with your pet’s age and/or if your pet has any concurrent health problems. In the rare case of emergency and I am unable to be reached by the hospital staff, I give Antelope Veterinary Clinic’s veterinarian and staff permission to perform any and all emergency care necessary and understand that additional cost will apply.

PREOPERATIVE BLOOD WORK: Includes a complete blood count, which evaluates your pet’s red and white blood cells, and a chemistry panel, which assesses electrolytes, kidney function, and liver function. Older animals tend to be at increased risk for complications during anesthesia. A physical exam, regardless of how thorough, frequently cannot detect metabolic issues, such as disease of the liver, kidney, or bone marrow. We recommend preoperative blood work for your pet before he or she undergoes anesthesia and surgery. (Additional fee)

HEARTWORM TESTING (DOGS)/FELV/FIV TESTING (CATS): As this geographic area is at higher risk for heartworm infection, our clinic highly recommends testing for heartworm disease if your dog has never been on prevention or has been off of it for more than six months. Heartworm infection increases the risks of complications under anesthesia. Feline Leukemia and Feline Immunodeficiency viruses are severe and fatal diseases. The viruses are transmitted through direct contact with other cats that carry the diseases. Complications from these diseases may increase the risk of complications under anesthesia. (Additional fee)

INTRAVENOUS FLUIDS: Older dogs (generally over 7 years) and/or sick dogs are better stabilized under anesthesia with IV fluids, which maintains blood pressure and circulation to vital organs. This also applies to healthy dogs undergoing lengthy procedures and dogs that may be pregnant. (Additional fee)

PAIN MEDICATION: Some procedures can be quite painful, and administering pain relief can increase your dog’s comfort level as well as speed the healing process. Your dog’s veterinarian can discuss with you what level of discomfort is anticipated for the procedure your dog is about to undergo.

FLEA/TICK PREVENTION: To protect the incision site from external parasites, and to protect the other patients in our hospital, we require all surgical patients to be free of fleas and ticks. If fleas or ticks are found on your pet, we will administer prevention. (Additional fee)

CANINE/FELINE SPAY: ALL FEMALE ANIMALS THAT ARE SPAYED WILL RECEIVE A TATTOO INDICATION NEAR THE INSISION SITE NOTIFYING THEY HAVE BEEN SPAYED: I
certify to my best knowledge that my animal is not in heat or pregnant. I understand that there is a higher surgical risk associated with the spaying of an animal currently in heat or pregnant. I understand that, at times, the doctor is unable to determine whether an animal is in heat or pregnant prior to the time of the procedure. I understand that if my animal is in heat or pregnant at the time of procedure, there will be additional charges. (Additional fee(s): IV catheter, Fluids, In Heat or Pregnancy charge)

TREATMENT PLAN: I understand that I have a right to request a treatment plan with an estimated cost for today’s procedure. I further understand that the treatment plan I was provided with is only an estimation and may vary by 20%. I have read and approved the treatment plan given to me for the animal receiving treatment today.

E-COLLAR: An e-collar, is an important tool in preventing a pet from interfering with their surgical site. After surgery, pets may experience discomfort as the incision heals, which can lead them to lick or chew at their incision. This can disrupt the healing process and potentially lead to infection or other complications. The e-collar acts as a physical barrier, preventing the pet from reaching the surgical site and causing further damage. Keeping an e-collar on a pet after surgery is crucial for a smooth and successful recovery.