Procedure & Anesthesia Consent Form

Client Information

Date *

Phone Number *

Owner Full Name *

Address *

City *

State *

Zip Code *

Companion Information

Pet's Name *

Species *

Breed (if applicable)

Sex *

Age *

As the owner or agent of the owner of the above animal, I hereby give my consent to Jackson Animal Clinic to perform the following procedures:

General Information Regarding the Procedure & Anesthesia

Pre-anesthetic Blood Safety Screen:
Our on-site laboratory lets us screen for hidden problems before your pet's treatment begins. These tests also provide us with a baseline for monitoring your pet during surgery and can indicate chemical imbalances that could affect your pet while under anesthesia. This is required unless blood work has been done in the past 6 months.

Anesthesia:
We use the same Isoflurane gas that is often used in human medicine. Isoflurane is primarily eliminated through the respiratory rather than through the kidneys or the liver. This helps to reduce the risks associates with anesthesia and allows doe a quicker recovery.

Monitoring:
Your pet is closely monitored through the entire procedure/anesthesia. Your pet's temperature, heart rate and rhythm, respiration, and oxygen levels are all continuously checked by our staff and anesthetic monitoring equipment.

Pain Management:
Your pet has the same type of nervous system that we do and will percieve pain in similar ways, but cannot express pain the same way we do. We require all animals undergoing surgery to receieve pain medication.

There will be an additional $48 charge for animals that are in heat or pregnant and being spayed. *

I understand

If your pet is here for a dental, the doctor will perform extractions as needed and there will be an addition charge for each extraction. Minor extractions are $8 and major extractions are $55. *

I understand

Additional Procedures Available

Intravenous Catheter with Fluids:
Administration of intravenous fluids helps your pet recover more quickly from anesthesia, maintains blood pressure and increases circulation during anesthesia. Surgical IV Fluids are important for all animals but REQUIRED for animals 7 years and older.

This procedure costs $42.

Would you like to include Intravenous Catheter with Fluids as part of your pet's procedure? *

Yes

Radiosurgery:
A specialized surgical unit which utilizes radiowave technology to make incisions minimizing pain at the incision site and improving the healing time of surgery.

This procedure costs $31.

Would you like to include Radiosurgery as part of your pet's procedure? *

Yes

By submitting this form, I understand that during the performance of this procedure, unforeseen conditions may be revealed that necessitate an extension or variance in the procedure(s) set forth as above. I expect Jackson Animal Clinic to use reasonable care and judgment in performing the procedure(s). The procedure(s) and risks involved have been explained to me and I realize that results cannot be guaranteed. I am also aware that unforeseen events resulting from the procedure(s) will not relieve me from my obligation to all reasonable costs incurred regarding the animal.

ALL ANIMALS MUST BE CURRENT ON ALL VACCINATIONS AND MUST BE FREE OF EXTERNAL PARASITES. ANY ANIMAL FOUND TO HAVE FLEAS OR TICKS WILL BE TREATED AT OWNER'S EXPENSE.

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