General Anesthesia Consent Form

Your Full Name *

Email Address *

Phone Number *

Has your address changed? If yes, provide us with the new address.

Type N/A if your address remains the same.

Pet's Name *

Breed *

Sex *

Age *

TREATMENT CONSENT

I hereby certify that I am the owner or duly authorized agent for the owner of the animal described above, and am of 18 years of age or over.

I understand that some risks always exist with anesthesia and/or surgery and that I am encouraged to discuss any concerns I have about these risks with the attending doctor before the procedure(s) is/are initiated. I understand that during the performance of the foregoing procedure(s) or operation(s), unseen conditions may be revealed that necessitate an extension of the foregoing procedure(s) or operation(s) that are set forth above. Therefore, I hereby consent to and authorize the performance of such procedure(s) or operation(s) as are necessary and desirable in the exercise of the veterinarian's professional judgment. I also authorize the use of appropriate anesthetics and other medications, and I understand that hospital support personnel will be employed as deemed necessary by the veterinarian.

I have been advised as to the nature of the procedures or operations and the risks involved, including the unfortunate possibility of complications causing death. I have had the tentative or final diagnosis explained to me. As well as any reasonable alternative course of action (if any) and risks/benefits of each. I realize that no guarantee can be made legally or ethically to me regarding the outcome of any procedure performed. I have carefully read and do fully understand this authorization and consent. I understand that the IV fluids and preanesthetic bloodwork which have been offered/ or are included in the price of this procedure are to help mitigate some of these risks.

Under legislation where there are no suitable medicines specifically authorized for the treatment of a particular species or a particular medical condition in that species, a medicinal product authorized for a different medical condition, or for use in another animal species or in humans may be used for the treatment of your animal. Such products will be used only when we consider them to be the most appropriate treatment.

The risks inherent in the procedures, treatments and anesthetics have been thoroughly explained and I accept those risks, including anesthesia mortality (0.1%) or infection (5%).

Treatment Consent *

I agree and understand the above stated risks

Has your pet been fasted? If yes, since what time? *

Is your pet taking any medications or supplements? If yes, what are the names of the medications and when were they given? *

Name of procedure being performed *

Would you like a free Nail Trim? *

Yes
No

PROCEDURE ACKNOWLEDGMENTS

Surgical Fluids & CBC *

I understand that both surgical fluids and a CBC are included in the price of the procedure to mitigate some of the risks associated with anesthesia.

Would you like additional bloodwork (Blood Chemistry) to determine organ function prior to being induced for surgery? *

Yes, I accept the additional costs associated with this procedure to a max of $169.17 dependent on age.
No, I do not accept the additional costs associated with this procedure.

Would you like a microchip ($53.79)? *

Yes
No

Would you like a FREE tattoo? *

Yes
No

Would you like a cone ($24.30) or after surgery shirt ($39.12) to prevent licking? *

Yes, I prefer a CONE
Yes, I prefer an AFTER SURGERY SHIRT
No, thank you

Does your pet require vaccinations at this visit ($19.95/vaccine)? *

Yes
No

ADDITIONAL TREATMENTS

If during the procedure there is a treatment not included in the estimate that the Doctor deems necessary, we will make every effort to contact you. In the event that we are unable to reach you at the contact numbers provided above, please choose a protocol for the Dr. to follow:

Choose an option *

Please PROCEED with additional treatments that the Doctor deems necessary, If you cannot reach me by phone.
Please DO NOT proceed with additional treatments if I am unable to be reached, unless in an emergency.

CPR CONSENT

By signing this, you choose to consent or not to Onoway Veterinary Clinic performing CPR on your pet. Cardiopulmonary resuscitation, or CPR, is the emergency treatment used for cardiac and/or respiratory arrest. This means that a patient's heart has stopped beating and/or the patient has stopped breathing. DNR means “do not resuscitate”. This is a decision that resuscitation (CPR) is not to be performed.

In the event of cardiac arrest where CPR is requested it is not always successful and the cost of performing CPR may be up to $200.

Choose an option *

CPR - I wish for Onoway Vet Clinic to perform CPR on my pet if he/she suffers cardiac/respiratory arrest
DNR - I do NOT want Onoway Vet Clinic to perform CPR on my pet if he/she suffers cardiac/respiratory arrest. I understand in the event that my pet suffers cardiac/respiratory arrest, he/she will pass away.

⚠️ Temporary Closure Notice

General Anesthesia Consent Form

TREATMENT CONSENT

PROCEDURE ACKNOWLEDGMENTS

ADDITIONAL TREATMENTS

CPR CONSENT

Our Cookies

About Cookies

Cookie settings

Functional cookies

Analytics cookies

Marketing cookies