Canine Pre-Anesthesia Consent Form

Client/Patient Information

By signing this form, you authorize the doctor to treat your pet as necessary should he/she be unable to contact you at the number(s) provided above.

Checklist

Pre-Anesthetic Blood Work

Bloodwork is performed to evaluate your dog’s health prior to anesthesia. The results of bloodwork screening can warn us about underlying conditions that could lead to possible complications. We are especially concerned with the condition of the liver and kidneys as these are the primary organs that metabolize anesthetic drugs.

Listed below is a description of bloodwork we offer. Please check the level of screening you would like for your pet. If your pet is 8 years of age or older, we highly recommend a senior blood panel.

Please select bloodwork(s) to be done:

Microchipping

We offer microchipping for your pet. This is a small chip that is implanted under your pet’s skin on the back of the neck that is used for identifying your pet may he/she get lost. We suggest that it is implanted while the pet is under anesthesia. This offer may or may not be included in the estimate provided.  Please check one of the following:

Dental Procedures

For patients scheduled for dental cleanings: a dental cleaning for dogs and cats involves a full mouth health examination, cleaning, and, if necessary, extraction of teeth. When a pet’s teeth are loose or abscessed, it is left to the veterinarian’s discretion as to whether or not they should be extracted. Cost is based on the length of time required to extract the teeth. Please speak directly with your pet’s veterinarian to determine approximate cost of extractions if not already provided on the estimate.  Please check one of the following in case any unexpected extractions are found:

Recovery Option

Your pet will need to remain calm and quiet throughout his or her recovery process (about 7 to 10 days).  Would you prefer to have medication at home that will help keep your pet calm?

Does your pet need to be updated on any vaccinations or other services while here?

Advance Directive for Resuscitation

To provide the safest anesthesia for your pet, we perform a thorough pre-surgical examination and pre-anesthetic bloodwork. During anesthesia your pet is being monitored by trained veterinary staff. Despite all of the precautions we take, anesthesia is never completely without risk. For this reason, we ask all clients about their wishes regarding CPR. Our hospital mission is to provide the best care for your pet and to update you regarding any changes in the condition of your hospitalized pet. In the event of a life threatening situation, we will contact you immediately.  Please advise us whether you would wish CPR (cardiopulmonary resuscitation) to be performed on your pet:

SPECIAL NOTES, PLEASE READ:

PARASITES

If parasites are found on your pet while hospitalized, we will treat the pet with the necessary treatment at the owner's expense for the protection of your pet and that of others in the hospital.

VACCINATIONS

All pets over six months of age are required to be vaccinated for rabies according to state law. If your pet has not had a rabies vaccine prior to his/her visit, or if proper documentation cannot be provided, the pet must be vaccinated for rabies.

I have read and understand the above information.

Sign Here