Anesthesia/Surgery Consent Form

Name(Required)

First

Last

Patient(Required)

Sex

Male

Female

Approximate DOB or Age(Required)

Species

Canine

Feline

Other

Breed(Required)

Procedure(Required)

I hereby authorize Falconbridge Animal Hospital and/or Village Veterinary Hospital to perform the above procedure on my pet. I understand that in the event additional procedures are deemed necessary, an attempt will be made to reach me before proceeding, but I understand that the veterinarians are authorized to perform any necessary procedures if they are unable to reach me.
I understand the nature of the procedure and that there may be risk involved. Further, no guarantee has been made as to results or cure.

A pre-anesthetic blood screen will be performed on all pets undergoing anesthesia or sedation. Because we will be using injectable and oral medications, it is important to know whether there are any detectable signs of organ dysfunction. The type of pre-anesthetic bloodwork is dependent on the age of the pet. The cost ranges from $64 to $152. (INITIAL HERE)(Required)

I understand that current Wellness Exams, Distemper, and Rabies vaccines are required for all pets, as well as Parvo, Bordetella, Flu Vaccine (H3N2), and a Fecal Flotation for dogs before admission to the hospital. Pets not current on vaccines/testing will be updated as long as it is deemed safe and advisable by a veterinarian. I understand that I am responsible for associated costs.

I certify that to the best of my knowledge my pet is free of all external parasites upon signing this release. If parasites, such as fleas or ticks, are found, I understand that my animal will be treated on admission for an additional cost.

Other services desired at additional cost:

Nail trim (complimentary)

Anal Gland Expression ($25.00)

Microchip Identification ($48.00)

Other

My pet has fasted for 12 hours:(Required)

Yes

My pet is on heartworm prevention:(Required)

Yes

We believe that keeping your pet as comfortable and pain-free as possible after the surgery will speed healing and recovery. Many animals do not show obvious signs of pain after surgical procedures, so it is up to us to provide them with pain relief both during and after procedures, before they show signs of discomfort. We use injectable medications both pre- and post- operatively. For continued pain relief at home, we provide either liquid or tablets.

I am aware that my pet will not be supervised overnight.

I have received an estimate for the above procedures and I understand that an effort will be made to contact me if any additional charges arise. I understand that all charges are my responsibility and that payment is expected at the time of discharge.

Falconbridge & Village Vets can use my pet's photos on FalconbridgeAnimal.com and their social media pages. (Like us on Facebook & follow us on lnstagram!)(Required)

Yes

Signature of Owner or Agent(Required)

Phone number on day of surgery(Required)

Date Signed(Required)

MM slash DD slash YYYY