Informed Consent for Anesthesia & Surgery

Owner’s Name______________________      Pet__________                 Date__________
I, being responsible for the above described animal have the authority to grant you my consent to receive, prescribe for, treat and/or operate upon my pet.

I understand the surgery or treatment contemplated is_____________________________
In addition: ___________________________________________________________________________

Of course there’s some risk:
FoxNest will use all reasonable precautions against injury, escape or discomfort to your pet.  But animals in stressful or unusual situations sometimes panic, hurt themselves trying to escape, get stress related diarrhea or get away from our handlers. Sometimes there are negative reactions to medications, anesthesia, or surgery.  We go to great lengths to prevent anything bad happening to your pet, but such things are risks that you assume.

I consent to the administration of such anesthesia as may be deemed proper by the doctor.  I also understand that any anesthetic procedure has some risk.  In general, we frequently use less expensive, injectable anesthesia for minor procedures BUT recommend or insist on using gas anesthesia for major, dangerous, or long procedures.  Gas anesthesia and the digital monitoring of blood pressure, oxygen saturation, EKG, and so forth that goes along with high quality anesthesia costs a little more.  We will gladly give you an estimate.

I acknowledge that no assurance or guarantee has been made of the results of surgery or treatment.  And that possible complications exist in any surgical or medical treatment. 

Fleas, Ticks, and Filth:  If your pet has fleas, ticks, or is covered in mud, mats, burrs, and so forth; we may charge you for a bath and/or parasite control.

FASTING:  Anesthesia on a full stomach increases risk of vomiting and aspiration.  I know this and have made sure my pet has not eaten in the last 8 hours.

Choices & Considerations:

Basic Blood Screening for kidney disease, liver disease, diabetes, & anemia ($32)

Extensive Blood Screening that also checks for infection, protein levels, electrolytes, and platelet levels ($52)

Doing at least basic blood work prior to anesthesia and surgery is a major part of making your pet's operation safe, comfortable, and sucessful.  We will discuss which of these pre-anesthetic lab packages is most appropriate for your pet.

We will also discuss which type of anesthesia will be most appropriate for your pet:

Injectable Anesthesia is less expensive and appropriate for quick procedures on healthy pets (Usually about $60)

Gas Anesthesia is more appropriate for longer procedures or for high risk breeds, older, weak, or sick patients. (Usually $90-120)

IV Fluids, Electronic monitoring, EKG's:  We will discuss whether or not your patient is likely to need any of these things.

Post Op Laser Therapy really helps reduce pot op swelling, pain, and inflammation.  And it speeds the healing process.  Highly recommended. $10

Pain Management is an automatic and included part of our surgery procedures, but we will add a small charge to your bill if we think additional pain medications are needed.  We will probably also recommend some post op pain medications to take home.  This will cost a few dollars.

Other Minor Procedures ... We will gladly do extra things you want done while your pet is under anesthesia such as toe nail trimming, ear cleaning, anal gland expression, wart, cyst, or mole removal, minor dentistry, dewclaw removal and so forth.  Usually on a very low or no charge basis

Microchip: It easy to microchip your pet while under anesthesia  ($32 all inclusive)

After carefully reading the above I have signed in agreement.

_____________________________________________date____________________



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Discussion about your choices and options if your Pet needs Surgery
It would be great if you printed this form out and brought it with you on surgery day