Surgery and Anesthesia Consent

Please fill out the consent form below, and a member of our team will get back to you shortly.

Consent Form

Please Note: Any fields with * are required. If you have any questions, please feel free to contact us.

Pet's Name *

Breed *

Color *

Male or Female *

Male
Female

Spayed/Neutered? *

Species *

Canine
Feline

Age/Date of Birth *

Weight *

As the owner (or authorized agent of the owner) of the animal described above, I hereby give my consent to perform the following procedures:

Consent for First Procedure *

Consent for Second Procedure

Consent for Third Procedure

Consent for Fourth Procedure

Your pet may have an intravenous catheter placed for the procedure(s). The use of intravenous fluids during surgery facilitates adequate cardiovascular performance, reduces stress on the heart, assists in maintaining your pet’s temperature, hydration, and blood pressure, and can reduce the time it takes for your pet to recover from anesthesia. The veterinarian and her anesthesia technician will determine if your animal will need an intravenous catheter and also determine if the use of intravenous fluids is warranted, this will be done on a case by case basis depending on many factors including but not limited to: the health of your animal, the type of procedure being performed, and the length of the procedure.

While undergoing these procedures your pet will receive anesthetic drugs that prevent pain. Because we care about your pet’s comfort and strongly believe that pain relief is important, additional pain medications will be provided, as needed, to control the level of your pet’s discomfort after surgery and during its recovery. Depending on the procedure other medication may also be provided, including antibiotics and sedatives.

I am the owner (or authorized agent of the owner) of Bayview Pup, the animal described above, and have the authority to execute this consent. I understand that some risk always exists with anesthesia, even in apparently healthy animals, including the possibility of death. I have discussed my concerns with the veterinarian and understand that it may be necessary to provide additional medical or surgical treatment to my pet in the event of unforeseen circumstances. I realize that no guarantee, legal or ethical, can be made to me regarding the outcome of any procedure performed. I hereby authorize the use of anesthetics and other medications, as well as any such additional treatment, as deemed necessary by the veterinarian. I understand that hospital personnel will be employed in treating my pet. I have carefully read and fully understand this consent. The fees associated with these services have been explained to me, and I agree to pay such fees at the time my pet is released from the hospital.

Cardiopulmonary Resuscitation *

Yes, if necessary, I do wish to have CPR performed.
No, thank you. If my pet passes away please do NOT resuscitate him/her

In the devastating event that your pet were to deteriorate and experience a cardiac arrest or respiratory arrest, no longer have a heartbeat or stop breathing our standard procedure would be to initiate Cardiopulmonary Resuscitation (CPR). Please note that costs of this can range from $300-$800+ depending on nature and duration of intervention. Under certain circumstances the veterinarian may recommend that resuscitation not be performed; as a pet owner you may prefer not to have resuscitation performed. In such cases you have the option to elect a Do Not Resuscitate (DNR) order.

Please note and understand that if one of our Bayview pet clients is found to have fleas, we have the right to treat at your expense. This is to prevent the spread of fleas to our other patients. *

Name *

First

Last

Best Contact Phone Number *

Email *

Date *

Signature *

Clear Signature

**The number provided above should be the number where we can contact you today. Please make sure that your phone's voicemail is set up to receive messages and that it is not full.

***Please note that if you are unreachable for any significant amount of time today, we will also need the information of an additional contact that has permission to make important decisions regarding your pet's health and wellbeing. Please inform this person in advance that you are providing us with their name and information and why we may need to contact them.

Alternate/Additional Contact Name *

Phone Number *

Phone

Schedule an Appointment

Surgery and Anesthesia Consent

Consent Form

Schedule an Appointment

360-373-1465

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