Surgical Consent Form Name* First Last Email* Secondary PhonePhone*Pet Name* Pet Species*Select OneDogCatRabbit* I can be reached at the following phone numbers between the hours of 8:00 and 1:00 pm during which the procedure will be performed I am authorizing the following procedure(s)*If declaw procedure, check one Front Back All 4 Please check the box next to each statement below once you have read it (All are required) * Pre-surgical blood work and physical examination will enable us to assess and minimize the risks associated with anesthesia for your pet. * Preparation – The skin around the surgical site will be clipped and scrubbed with antiseptic. We follow sterile procedures (surgical prep, surgical packs, and surgical attire). * Monitoring - We further minimize risk by monitoring heart rate and rhythm, respiration rate and quality, oxygenation, and depth of anesthesia during the procedure. We have licensed technicians monitoring. * Pain management - We are proactive with appropriate pre-op, intra-op, and post-op pain management medications. * Fluid therapy: IV Catheter or subcutaneous fluids- To support kidney function and blood pressure during anesthesia, we include fluids administered either through an IV catheter or subcutaneously. IV catheter does leave a small shaved spot on a front leg. Initial for consent to shave a spot for catheter* Initial aboveIs your pet Male or Female?* Male Female To my knowledge* My animal is NOT in heat or pregnant. My animal IS in heat or pregnant. Last heat cycle?* Post-Op Cold Laser Therapy Included with Procedure: Initial aboveIs your pet on any medication at home already?* Yes No What Type* Would you like your pet microchipped during their procedure(s)?* Yes No Already Microchipped I have been shown a treatment plan for this procedure(s).* Yes No I would like to receive a treatment plan via* Phone Email I authorize anesthesia/surgery for my pet. The nature and risks of this procedure have been explained to me. I understand that some risks always exist with anesthesia and/or surgery, and I am encouraged to discuss any concerns I have about those risks with my veterinarian before the procedure(s) are initiated. My initials on this consent form indicate that any questions have been answered to my satisfaction.* Initial aboveI authorize Ridgeview Animal Hospital to perform any additional diagnostic, treatment, or surgical procedures deemed necessary for medical or surgical complications or otherwise unforeseen circumstances. While Ridgeview provides the highest quality of anesthesia monitoring and surgical services, I understand that there are rare complications with any anesthetic or surgical procedure. My initials on this consent form indicate that no warranty or guarantee has been given to me as to the results or cure afforded by these treatments or procedures.* Initial aboveI understand that if my pet is kenneled overnight, there are no staff members present after hours.* Initial aboveMy initials on this consent form indicate that I fully understand these risks and understand that the veterinarians and hospital staff will try to minimize such risks. I will not hold Ridgeview Animal Hospital, the veterinarians, or any staff member liable for any complications that may arise.* Initial aboveE-collars will be sent home as a part of the procedure, prices and size will vary.* Initial hereI HAVE READ AND UNDERSTAND THIS AUTHORIZATION AND CONSENT* Reset signature Signature locked. Reset to sign again Signature above Δ
