Surgery Consent Form printable pdf download

GLEN MELTON, DVM

10735 McCreight St.

PATRICK MURRAY, DVM

Bastrop, LA. 71220

JEAN AULTMAN, DVM

TEL (318) 283-0656

FAX (318) 283-0680

Surgical Consent Form

If your pet is to be anesthetized, rest assured that advances in anesthesia and surgery have made routine

procedures relatively safe with a very low rate of complications. Like you, our greatest concern is the well-being of your pet.

Nevertheless, occasional problems can arise due to pre-existing conditions not evident during routine pre-anesthetic exams. To

avoid those problems, we recommend that all of these cases be screened prior to anesthesia by means of laboratory blood tests

that check liver, kidney, and glucose, as well as complete blood counts. The cost of these important tests is $46.50 added to cost

of surgery.

Would you like your pet to receive pre-anesthetic blood screening?

___________ YES, I want my pet to have a pre-anesthetic blood screen.

___________ NO, I decline pre-anesthetic blood screening for my pet at this time.

Even though our pets cannot effectively tell us if they are in pain, they do experience post-surgical discomfort the same

as we do. We highly recommend post-surgical pain medication for all surgeries. In some cases surgeries or procedures are more

extensive and require post-surgical pain medication.

Would you like your pet to receive post-surgical pain medication?

__________YES, I want my pet to receive post-surgical pain medication.

__________NO, I decline post-surgical pain medication for my pet.

ALL ANIMALS ADMITTED MUST BE CURRENT ON THEIR VACCINATIONS AND MUST BE FREE OF

EXTERNAL PARASITES. ANY ANIMAL FOUND TO HAVE FLEAS OR TICKS WILL BE TREATED AND

VACCINATIONS WILL BE GIVEN AT THE OWNERS EXPENSE. The required vaccines include: DOGS: DA2PLCPV

(7 in 1), Bordatella (kennel cough), and Rabies Vaccine. CATS: FVRCP (4 in 1) and Rabies Vaccine. Feline Leukemia

Vaccination is recommended for any cat that goes outdoors but is not required for surgery admission.

Please check any additional services you would like your pet to have while under anesthesia:

______Clip Nails

______HomeAgain Microchip

______Clean Ears

______Skin (checked by veterinarian)

______Express Anal Glands

______Extract baby teeth

______Other_________________________________________________________

Please fill out completely:

Signed (owner/agent):________________________________________________Pet’s Name:__________________________

Breed/Sex: _________________________________Procedure:__________________________________________________

Date:______/______/______ Emergency Contact &Phone Number:_____________________________________________

Surgery Consent Form