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Surgery Consent Form
Surgery Consent Form
Allen Craig, DVM
Amanda Wesson, DVM
As owner/caregiver of the pet described above, I hereby give my consent to Lebanon Animal Hospital to perform the following procedure under general anesthesia:
I understand that if my pet is found to have external parasites, he/she will receive treatment at my (the owner’s) expense.
I also authorize the use of appropriate anesthetics, and other medication, and I understand that hospital support personnel will be employed as deemed necessary by the veterinarian. I have been advised to the nature of the procedures
or operations and the risks involved. I realize that results cannot be guaranteed. I have read and understand this authorization and consent. While Lebanon Animal Hospital provides the highest quality of anesthesia monitoring and surgical services, I understand the risks and understand that the veterinarians and hospital team will do everything possible
to reduce any risks. I will not hold Lebanon Animal Hospital, the veterinarians, or any team member liable for any complications that may arise.
Avid Microchip: While under anesthesia, I would like my pet implanted with an Avid microchip. Price $46.30
I, authorize resuscitation measures in the event that my pet needs emergency care.
I, decline resuscitation measures in the event that my pet needs emergency care.
Pre-Anesthetic Testing Consent Form
Your pet is scheduled for a procedure that requires anesthesia. We would like to take this opportunity to recommend pre-anesthetic testing and explain why it is important to the health of your pet.
Like you, our greatest concern is the well-being of your pet. Before placing your pet under anesthesia, a veterinarian will perform a complete physical examination to identify any existing medical conditions that could complicate the procedure and compromise the health of your pet.
Because there is always the possibility a physical exam alone will not identify all of your pet’s health problems, we strongly recommend a pre-anesthetic profile (a combination of tests) be performed prior to anesthesia. The tests we recommend are similar to and equally as important as those your own physician would run if you were to undergo anesthesia.
It is important to understand that a pre-anesthetic profile does not guarantee the absence of anesthetic complications. It may, however, greatly reduce the risk of complications as well as identify medical conditions that could require medical treatment in the future.
The combination of blood tests recommended for pets less than 6 years old. CBC (red blood cell, white blood cell and platelet counts) Price $96.40
BUN/CREA (kidney enzymes)
ALB/GLOB/TP (protein levels)
ALKP/ALT (liver enzymes)
GLU (blood sugar)
The combination of blood tests is required for pets over 6 years old. CBC (red blood cell, white blood cell and platelet counts) Price $195.90
Electrolytes (NA/K/Cl) BUN/CREA (kidney enzymes) ALB/GLOB/TP (protein levels) ALKP/ALT (liver enzymes) GLU (blood sugar) GGT/TBili (liver/gallbladder) CA (calcium level) CHOL (cholesterol level) PHOS (phosporus level)
Please complete the recommended testing prior to administering anesthesia to my pet.
I decline the recommended pre-anesthetic tests at this time and request you proceed with anesthesia.
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