Name

First Name Last Name

What is your pets name?

What is a phone number where you can be reached TODAY

Please List ALL the procedures you wish to have performed on your pet

Is your pet on any medications?

Recommended Pre-Surgical Testing Options:

Your pet will undergo full anesthesia today. If there is a pre-existing condition that we are not aware of, it may increase anesthetic risk. If you have any questions, please feel free to discuss them with one of our technicians.

Pre-Anesthesia Blood Screening: Pre-anesthetic bloowork gives the doctor an inside look at your pets vital internal organs. We are especially concerned with the liver and kidneys as well as the red blood cells and clotting factors. We strongly recommend having the bloodwork testing performed to help ensure the health of your pet. If your pet is six years of age or older, bloodwork is mandatory.

Yes, I would like the recommended blood test (required for pets over 6) No, I declined the recommended blood test. I understand the increased risk that may be associated with this decision. N/A, my pet has had bloodwork within the last 30 days.

Additional Optional Services:

Home Again Microchip and Registration: a safe and traceable method of permanent pet identification ($50) Parasitic Disease Screen for Heartworm, Lyme, Ehrlichia and Anaplasmosis ($55) Feline FelV/FIV ($57) Nail Trim (complimentary) Ear Cleaning ($15)

SPAYS AND NEUTERS ONLY

At RVUC, we offer low cost / high quality spay and neuters. This means that there are additional options you can elect for your pet. Both are recommended, but will add additional cost to your estimate.

Type a question

I want my pet to have an additional post op pain injection (anti-inflammatory). Please note all pets will receive the standard post op injection, this one is for additional pain control and inflammation (approx $30-$50) I want my pet to receive an anti-nausea medication if needed (approx $30-$50)

NOTE:

If an E-Collar is deemed necessary for your pet, one will be dispensed to you. If you choose to decline, RVUC will not be held accountable for any complications arising from your decision.

If your pet is found to have parasites (fleas) treatment will be given in hospital to protect the safety of the other pets. You will be responsible for any corresponding charges.

Please read and review carefully:

I am the owner (or authorized agent of the owner) of 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. 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, 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 in full at the time my pet is released from the hospital.

Signature

Clear

Date

Anesthesia Consent Form

Anesthesia Consent Form

Contact:

Directory: