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Consent for Treatment

Consent for Treatment
Owner's Name
Owner's Name
First
Last
CONSENT FOR TREATMENT

I 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.

I have read and understand this authorization and hereby accept and agree to the terms of the consent for treatment.
Additional Costs
We have done our best to provide you with an estimate of the cost for the procedures we anticipate providing for your pet today. However, during the course of providing treatment, we may find that it is necessary to perform other procedures, run lab tests, use sedation or anesthesia, or prescribe medication to best serve you or your pet which might be over the estimated cost previously presented to you.

Please note: If you check C, we may not be able to do everything needed for your pet’s safety and comfort if we cannot reach you. You acknowledge that if your pet is under anesthesia and we cannot reach you, your pet will be woken up and you will incur additional charges to anesthetize your pet at a later date to complete the procedure(s) needed.

In the event any of these procedures are deemed to be in the best interest of my pet, I authorize the option I marked below:

Contact Information for Today

Name
Name
First
Last
Secondary Contact Name (optional)
Secondary Contact Name (optional)
First
Last
Would you prefer a call and/or text today following your pet's procedure.

Current Medications and Supplements

Please be sure and continue all medications prior to surgery, including the morning of. A small meatball of food may be fed to administer medication if needed. If your pet is a diabetic and receives insulin in the morning, please administer ½ the amount of insulin in the morning and with ½ of morning meal unless instructed otherwise by your veterinarian.
CPR
Prior to the procedure today we have done our due diligence to ensure that your pet is in good health and has an expectation of a full recovery. We will be conducting another exam prior to the procedure today to assure no changes have taken place since the last exam. Despite these measures, in the unlikely event 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 and notified of their status?

By consenting to this service, you are also acknowledging that certain fees will apply. (Treatment cost range of $500-$1000) If you are not able to be contacted immediately, resuscitation efforts will continue or stopped based on the response and prognosis for a successful outcome determined by the veterinarian. Please initial your choice below.

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