Step 1 of 333%Name(Required) First Last Patient Name(Required)Procedure Being Performed(Required)Best phone number to reach you at(Required)To your knowledge, has your pet ever experienced complications under anesthesia?(Required) Yes. My pet has experienced complications under anesthesia No. My pet has undergone anesthesia without complications I am unsure whether my pet has experienced complications under anesthesia My pet has never been under anesthesiaIf yes, describe what happenedIF your pet is having a Dental ProcedureHas your pet received previous dental care? Dental Chews Teeth Brushing Dental Cleaning without Extractions *requires anesthesia* Dental Cleaning with Extractions *requires anesthesia* None of the AboveDuring the dental procedure the patient's dental health will be assessed by a thorough dental exam and dental radiographs. It may be deemed necessary for the pet's health and comfort that dental extractions are performed. Do you consent to extractions under veterinarian discretion? I consent to any recommended extractions. I would like to be called before any teeth are extracted.Pre-op Bloodwork is required within 30 days of surgical procedures. Please enter the date of last known bloodwork. *Please note: we will collect blood the morning of the procedure if bloodwork is not up to date(Required)We recommend that your pet be microchipped while under sedation if he/she isnt already. The cost of the Microchip is $50. Would you like for your pet to receive one?(Required) Yes No Already Microchipped. Please Scan and update system. Im not sure if my pet is microchipped, Please Scan and implant one.Complimentary Nail Trim?(Required) Yes NoAny other requests while your pet is sedated? (vaccines, anal glands, ear cleanings, check lumps, etc)(Required) Yes NoPlease list your requests(Required)Is your pet currently on any medications?(Required) Yes NoPlease list every medication that your pet is on(Required)Is Your Pet allowed to have bedding? Yes NoI am the owner or the authorized agent for the owner of the animal described above, and I have the authority to execute this consent. My signature below certifies that I am over eighteen years of age.I have been informed that there are certain risks and complications associated with sedation, anesthesia, and/or any operation/procedure and that the risks/complications have been explained to me. I further understand that during the course of the operations or procedures, unforeseen conditions may arise that may necessitate the performance of additional procedures deemed necessary by the veterinarian. I am encouraged to discuss any concerns I have about these risks with the attending veterinarian before the procedure is initiated.I authorize the use of appropriate anesthesia and pain relief medication as needed before, during or after the procedure. I have been informed that there are risks associated with the use of any medication.The nature of these operations or procedures has been explained to me and I understand what will be done. I am aware that the practice of veterinary medicine is not an exact science and, thus, there are no guarantees for successful treatment. I have been encouraged and given the opportunity to discuss any questions I may have regarding my pet's medical care and my questions have been answered to my satisfaction. I accept that my financial obligations remain regardless of the outcome.E-signature/Consent(Required) I have read and understand this authorization and hereby accept and agree to the terms of the consent for treatment.CPRIn the event that your pet should experience cardiac or respiratory arrest while being hospitalized today, do you give consent for resuscitative efforts to be initiated until you can be contacted further and notified of your pet's status? By consenting to this service, you are also acknowledging that certain fees will apply. If you are not able to be contacted immediately, resuscitation efforts will be continued to be performed at the doctor’s discretion. Please select your choice below.(Required) I agree for CPR to be performed in the case of cardiac arrest I elect a "Do Not Ressucitate" status in the case of cardiac arrest Are you passionate about making a difference in the lives of animals?If so, we want to hear from you!REACH OUT TODAY
