General Surgery Consent Form

General Surgery (Lump Removals, Biopsies, Non-Elective Surgeries)

The animal will be placed under general anesthesia (in some circumstances the pet will placed under heavy sedation) and will return home in the same day. The animal will receive an intravenous infusion of fluids, which helps maintain blood pressure and allows for a better recovery. There will be a shaved patch on the front leg from the intravenous catheter. The area of concern will also be shaved. They will also receive anti-inflammatory medication at surgery and to continue once home.

*Additional medications may be added to go home (additional pain medications, antibiotics, etc.)*

Follow up:

If external sutures are placed, they will need to be removed by veterinary staff in 10-14 days.

If no external sutures are placed, then an incision check is recommended in 10-14 days with one of our technicians (complimentary).

If your pet has a Fentanyl patch placed, this will need to be removed by veterinary staff in 3-5 days.

If your pet has a drain placed, this will need to be removed by veterinary staff in 3-5 days.

Which practice would you like to register with?

Location

{$ IvcPractices.Form.Label.SecurityQuestion }

Full Name *

Best Phone Number

Address *

City *

Province *

Postal Code *

Email Address *

Alternative Contact Number

Pet's Name *

Pet's Date of Birth *

As the owner (or agent of the owner) of the animal described above I authorize and request Clayton Park Veterinary Hospital to hospitalize this animal for the purpose of a diagnosis, treatment, surgery or other procedures, as specified by this release and approve the use of the required anesthetics as prescribed by the attending veterinarian.

Your pet is being admitted for anesthesia/surgical procedure. To ensure your pet is in a low risk category prior to anesthetic we will be performing a blood profile. The blood profile is performed on site here at the hospital. This will enable us to have a base line reference prior to surgery and also act as a reference in the future should your pet become ill.

I, (the signee) understand that Clayton Park Veterinary Hospital will use reasonable caution to ensure my pets safety while it is in your care but will not hold Clayton Park Veterinary Hospital responsible if injury, escape or demise were to occur. By signing this document, I absolve Clayton Park Veterinary Hospital of liability for the procedure requested herein.

I understand that a more detailed examination under anesthetic may reveal further dental issues not anticipated on initial exam. Pet Focus - Clayton Park Veterinary Hospital will contact me with any changes to this treatment and or diagnostic plan as they arise.

I understand that payment is due at the time that services are rendered.

In the event that I am unavailable for contact and additional procedures may be deemed necessary at the discretion of the attending veterinarian:

Please select one *

I give consent for the additional procedures and I will be responsible for additional costs related to those treatments or diagnostics.
I do NOT consent to the additional procedures and I understand that this may lead to higher future costs and potentially delay treatment, which might not be in my pet's best interest.

Medications and Supplements

This includes medications for managing disease, human medications such as tylenol, supplements (fish oils, other joint supplements), etc.

Please provide a detailed list of the medications your pet takes. Please include the drug name, the amount your pet receives and how often your pet is given the medication.

Is your pet on any medications or supplements currently?

Yes No

Please write your pet's medications below:

When was the most recent access your pet had to food and water? *

Cardiopulmonary Resuscitation (CPR)

I understand that some risks exist with anesthesia and or surgery, including death, even in apparently healthy animals and I am encouraged to discuss my concerns regarding these risks prior to the procedure. Should some unexpected life saving emergency care be required, I request the following actions be taken:

CPR Consent *

Attempt to resuscitate my pet through use of chest compressions, medication administration, artificial respiration deemed appropriate by the attending Veterinarian.
Do not resuscitate. I understand that if no life-saving measures are taken, my pet will pass away.

- I accept that if the staff are unable to reach me within 15 minutes after CPR has been initiated and after exercising reasonable medical judgement, is determined there is still no signs of life, the staff will cease further CPR procedures.

- I understand that despite the best efforts of the veterinarian and staff, even the most successful CPR that restores my pet's life, may not allow for my pet to regain their normal mental and physical health.

Signature *

Today's Date *

Today

Security Question *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *