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Surgery and Anesthesia CONSENT FORM

Please answer the following questions to the best of your ability: 

Pet Name:

Owner's Name:

Date:

Phone Number:

Procedure/Surgery to be performed:

Please answer the following questions to the best of your ability:

Has your pet been fasting since midnight the night before surgery?
Please answer the following questions to the best of your ability:
A
B
Has your pet taken any medications in the last 24 hours?
Untitled multiple choice field
A
B
If so, Please list what medications, dose, time and frequency:

Pain Management- All animals will receive pain management medication as deemed necessary by procedure. The cost will vary by medication and size of the animal.

Please read this sheet and select your preferences for the following options:

Pre- Anesthetic Bloodwork (~$145.00) Includes a Complete Blood Count and Comprehensive Serum Chemistry Panel

Pre- Anesthetic Bloodwork (~$145.00) Includes a Complete Blood Count and Comprehensive Serum Chemistry Panel
A
B

Microchip Placement (~$42.00)

Microchip Placement (~$42.00)
A
B

Therapeutic Laser Treatment (~$12.00 add on fee)

Therapeutic Laser Treatment (~$12.00 add on fee)
A
B

Nail Trim (~$10 add on fee)

Nail Trim (~$10 add on fee)
A
B

Mass Removal, send off mass for further testing ($120)

Mass Removal, send off mass for further testing ($120)
A
B

E-Collar To Go Home (price based on size ~$15+)

E-Collar To Go Home (price based on size ~$15+)
A
B

I have read the consent sheet and understand the relative risks and procedure being performed today. I hereby authorize and direct Wilkes County Veterinary Services to perform the procedure/surgery listed above and to administer anesthetics or other drugs as deemed advisable for my pet. I understand the nature of the procedures and the relative risks involved, and I authorize Wilkes County Veterinary Services to provide any appropriate care should an unexpected complication arise.


Owner Signature:

Signature

Best Number to Reach at today:

Pre-Anesthetic Bloodwork- Our on-site laboratory lets us screen for hidden health problems before your pet’s surgery begins. These tests also provide a baseline for monitoring your pet during surgery, and can indicate chemical imbalances that could affect your pet under anesthesia. For our mature patients (over 7 years of age) and for any pets that have chronic health problems, we may recommend more extensive blood tests. Even for our healthy, younger patients, pre-anesthetic blood testing can help by diagnosing underlying issues and help ensure the procedure is safe to continue. Pre-operative blood work is also used to monitor changes as your pet ages. On rare occasions, medical problems are detected that change our plans. 

Surgical Monitoring- Your pet’s heart rate and rhythm, respirations, and oxygen levels are closely monitored during surgery. The procedure/surgery is performed on a special re-warming blanket, which helps to maintain your pet’s body temperature. Your pet will also be closely monitored after surgery until they are awake and can safely be placed into a cage alone. 

Intravenous catheter with fluids- Administration of intravenous fluids helps the patient recover more quickly from anesthesia, maintains blood pressure and increases circulation during anesthesia. The intravenous catheter is also used to administer any medications needed during the procedure. Most procedures will require an IV catheter to be placed in a leg vein prior to anesthesia and this catheter will be removed before your animal goes home. 

Microchip- Home Again microchips allow a unique ID number to be placed and assigned to your pet. This number links to a national database that can be looked at and allow you to be contacted if your pet is lost and found by someone else. You must keep your information up to date as time goes on. 

Therapeutic Laser- The laser treatment promotes healing of the surgical site by decreasing pain and inflammation and increasing blood flow. Treatment is quick, comfortable, and effective. We recommend therapeutic laser treatment for post-operative patients. There are rare occasions where laser treatment is not recommended, such as removal of suspected cancerous lesions and neutering of male cats. If you select to have your pet receive laser treatment and we do not believe it is in your pet’s best interest, we will inform you of such.

Tattoos- All altered female animals and male dogs will have a small tattoo placed by their incision. This allows veterinarians to know that the animal has been altered and can prevent them from going through another procedure in the future.

Estimates- Estimates of procedures can be provided upon request. These estimates are just estimates and the cost can vary due to medications, unforeseen circumstances and complications. 


Fleas/Ticks- If your pet has fleas or ticks while here for surgery, it will be treated at the owner’s expense. 


Anesthesia and Surgery- All procedures have a risk of complications that vary from case to case. We do our best to minimize any complications. Complications that can arise can vary from incisional infections to anesthetic death. 

If you have any questions or concerns regarding the recommended procedures or surgery, please speak to one of our doctors prior to leaving your pet.