Hurricane Animal Hospital Consent before Anesthesia & Surgery
We have _____________(pet’s Name)_ scheduled for: __________________________________(procedure)_ on ___________(Date)_, 20_____. Please arrive at the hospital at __________ am for admission to hospital prior to surgery/anesthesia.
OWNER PLEASE READ ALL INFORMATION BELOW: Please schedule to be able to spend 10-15 minutes handling paperwork & discussing care before leaving your pet. The anesthesia & procedures will be done in the morning, & a nurse will call you with updates between noon & 2pm to confirm your pets’ release time. Releases typically occur between 4:30- 6pm, but since pets respond differently to anesthesia, some are ready to go home earlier & some later. Like you, our greatest concern is your pet’s safety & well-being during anesthesia. If acceptable lab tests have NOT been completed, we strongly recommend these before your pet has anesthesia. Please initial the desired profile below OR sign the statement below to decline this service. IF your pet had blood testing completed in advance leave this section blank until your admission appointment.
Type a question
Profile #1 – recommended for all pets 2 years old & under in good health. $116.62. (Chem8+ cartridge and ECG)
Profile #2 – recommended for pets age 2-7 years or with questionable health. $144.65 (Comprehensive Dx Profile, CBC, & ECG)
Profile #3 – recommended for all pets over 7 or with illness/conditions requiring thyroid check. $245.60. (Comprehensive Dx Profile, CBC, T4/Chol, urinalysis strip and specific gravity, & ECG)
I have read the brochure explaining pre-anesthesia blood testing & have had the opportunity to ask questions to the staff members and/or doctors at Hurricane Animal Hospital. I have chosen to decline the recommended pre-anesthesia blood work at this time & request that you proceed with anesthesia.
Please initial or check to accept or decline for the following commonly performed services to be done while your pet is sedated:
Please provide me with flea prevention/heartworm prevention refills.
Please biopsy the growths being removed during surgery. ($134.99 for one biopsy, $147 for two)
Please trim my pet’s nails ($13.31)
Please clean my pet’s ears ($13.55)
Please microchip my pet ($55.72)
Canine Influenza ($35)
Feline Leukemia ($21.22)
Other Services Needed:
ALL PETS WILL RECEIVE AN INJECTION FOR PAIN CONTROL IN THE HOSPITAL & MEDICATION TO PROVIDE RELIEF FOR 3-5 DAYS AFTER SURGERY. I am the owner/agent for the described animal and I authorize & request the services listed on this form and/or outlined on the estimate provided for my pet’s care. I understand, and accept that when anesthesia is involved, there are always inherent risks, including death. I have indicated any additional services I would like performed. I understand that pain medication will be provided to keep my pet comfortable after the procedure. I can be reached at ________________________ if needed for questions during the surgery. Further, I understand that if I am unreachable at the time, Hurricane Animal Hospital will determine what is medically in the best interest of my pet and proceed in that manner. I understand I will be financially responsible for these services.
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