Surgical Consent Form Client Name: Pet Name: Procedure: Date MM slash DD slash YYYY Intravenous Fluids Intravenous fluids given during surgery are strongly recommended for every pet undergoing anesthesia. IV fluids help maintain normal blood pressure, correct dehydration from being fasted, increase the metabolism and excretion of the anesthetic medications and provide rapid administration of lifesaving drugs should an emergency situation develop. There is an additional charge for IV fluids. Would you like your pet to receive IV fluids during surgery? Yes No Pain Management Any surgical procedure carries with it the unfortunate side effect of post-operative discomfort. We now believe that pets experience pain to a much higher degree than we originally thought. Medication to control pain is available and can be sent home after surgery with your pet. The cost of this medication will vary according to your pet's weight.Would you like your pet to get prescription pain medication? Yes No Microchip ID System While your pet is under anesthesia, we can implant a small microchip under the skin between the shoulder blades. The chip is encoded with a unique identification number. The procedure is safe and the microchip is not visible under the skin. The microchip cost includes the lifetime registration fee.Do you want your pet micro-chipped while under anesthesia? Yes No If yes, please provide the following information for the microchip registration:Email address Phone2nd contact person name and phone # Dentistry Appointments For pets scheduled for a dental cleaning under general anesthesia: During the course of a routine dental cleaning, the doctor may discover teeth that need to be extracted. If the doctor determines there are teeth to be extracted, do you consent to have this done? There is a charge for each tooth extraction. If you wish to be called with an estimate first, you must provide us with a phone number that will be answered promptly as your pet will be under anesthesia and prolonging anesthesia time waiting for a client to call back can be detrimental to your pet's health. extract teeth if needed. Yes, extract teeth if needed. No Call with estimate first. Phone #: Surgical Consent I certify that I am the responsible party for this pet. I understand that general anesthesia carries with it certain risks, and that death from anesthesia, while rare, can happen. I have been offered intravenous fluids and pain management medications and have indicated my choices.Untitled I am authorizing Stella Link Animal Clinic to perform such diagnostic, therapeutic and surgical procedures as described above. Client Signature: Reset signature Signature locked. Reset to sign again Best phone number to reach you at today?
