SurgeryConsent Form

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Surgery Consent Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Name *

First

Last

Email *

Pet's Name *

Pet's Age *

Procedure Your Pet Is Receiving *

Anything else needed while pet is under anesthesia?

Emergency Phone Number *

Anesthetic Procedures and Risks

At Golden Heart Veterinary Services, we use a combination of pre-anesthetic medications and injectable and/or inhalant anesthetics to obtain optimum levels of anesthesia for your pet. For short procedures, an injectable anesthetic is given alone, which produces an appropriate plane of surgical anesthesia with a quicker recovery time.

For most procedures, your pet is anesthetized and then intubated (insertion of a tube into the trachea or windpipe). This ensures your pet is able to receive oxygen at all times and prevents aspiration of any fluids into the lungs. Anesthesia is maintained with a gas anesthetic, Isoflurane, that is very safe and metabolized by less than 1% of the liver. Inhalant anesthetics allow us to have better control over anesthetic depth in our patients.

Monitoring and Pain Management

Patients under anesthesia are monitored in two ways. First, a veterinary assistant is with your pet from the introduction of anesthesia all the way through until recovery. Second, your pet's pulse, heart rate, oxygen level, ECG, respiration, and temperature are all tracked and displayed on a computerized monitor.

Being in pain is no fun. We take all necessary steps to ensure your pet’s pain is appropriately managed before, during, and after surgery. This will often include prescribed pain medication to take home post-operation.

Intravenous Catheterization and Fluids

We place an IV catheter and use IV fluids during almost all anesthetic procedures, with only a few exceptions. These allow for quicker recovery from anesthesia, as well as provide quick access to the circulatory system in case of an unforeseen emergency.

At Golden Heart Veterinary Services, we strive to provide the highest quality care for your pet. We will always provide you with our recommendations for appropriate precautions in order to avoid potential problems; however, it is important for all our clients to understand there is always an inherent risk of complication with any anesthetic or surgical procedure. We are thankful and honored that you have chosen to entrust the care of your pet to us.

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 and understand that it may be necessary to provide additional medical or surgical treatment to my pet in the event of unforeseen circumstances. 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 and other medications, as well as any such additional treatment, 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. *

I have read and understand

Signature *

Clear Signature

Date *

SurgeryConsent Form

Surgery Consent Form

Anesthetic Procedures and Risks

Monitoring and Pain Management

Intravenous Catheterization and Fluids

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