Surgical Form

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Please provide your contact details and consent, choose pre-surgical options like bloodwork, fluids, pain control, and CPR, and authorize anesthesia and surgery for your pet.

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Owner Information

Your Name(Required)

Emergency Contact

Emergency Contact Name(Required)

Owner Authorization

I have the authority and I authorize the treatment and/or surgery for my pet, and I am aware of the following:
I have received a written estimate of the costs involved. IT IS ONLY AN ESTIMATE.
Pre-Surgical Blood Work(Required)
There are inherent risks involved with the use of anesthetics. One way to minimize this risk is to make sure there are no problems with internal organs that would compromise anesthetic safety. Pre-surgical blood work is performed to determine if your pet is healthy enough to undergo general anesthesia. Some internal problems are not apparent during a physical examination and may only be detectable when pre-operative blood screens are performed. Anesthesia lowers the blood pressure which could harm internal organs like the liver and kidneys if these organs are not healthy.
Intravenous Fluids(Required)
Intravenous fluids are given when general anesthesia is required to keep the blood flow to the kidneys normal. This is important for animals that are very old, have medical problems and any pet that is dehydrated.
Pain Relief Medication(Required)
Surgical procedures can be painful. We make every effort to keep your pet comfortable before, during and after surgery/treatment. An injection to alleviate pain after surgery/treatment is strongly recommended. In some cases oral pain relieving medication for owners to give at home will be prescribed.
Cardiopulmonary Resuscitation (CPR)(Required)
If cardiac and/or respiratory arrest occurs (that is, if a pet stops breathing and/or his/her heart stops beating) then cardiopulmonary resuscitation (CPR) will be performed to revive the pet upon your request.
Has your pet ever had any reactions to anesthesia(Required)
I authorize the use of appropriate anesthetics and other medications. I have been advised of the nature of the procedure(s) and the risks involved. I realize that results cannot be guaranteed and I assume all risks of anesthesia, surgery and failure to follow post operative care instructions including cage rest and the use of an e-collar. Without an e-collar, your pet is capable of scratching, biting and traumatizing the surgical site impeding recovery and possibly leading to secondary infection and the need for additional surgery at an additional cost to you. An e-collar must be worn until full recovery is achieved and sutures are removed.
Owner Signature(Required)
SMS Consent
Email Consent