Anesthesia Consent

I, the undersigned Owner or agent of the pet identified above, and am of 19 years of age or over, authorize the staff of Petsville Animal Hospital to perform the above checked procedure(s).

I understand that some risks always exits with anesthesia and/or surgery and that I am encouraged to discuss any concerns I have about those risks with my veterinarian before the procedure(s) is/are initiated.

My signature on this form indicated that any questions I have regarding the following issues have been answered to my satisfaction.

The reasonable medical and/or surgical treatment options for my pet
Sufficient details of the procedure to understand what will be performed
How fully me pet will recover and how long will it take
The most common and serious complications
The estimate of the fees for all the services

While I accept that all procedures are performed to the best of the abilities of the staff at this hospital. I understand that no guarantee or warranty has been made regarding the results that may be achieved.

I also assume full responsibility of any additional expenses incurred after the surgical procedure is performed, such as follow up radiographs, re-check physical exams, and any additional surgery due to post-op complication. These are likely to occur when there is a failure to comply with the after care instructions.

Pre- Anesthetic Blood Panel: A complete physical exam will be performed on your pert prior to the surgical procedure if it has been more than 30 days since the last exam. However, this may not identify all systemic and metabolic problems. For this reason, a pre-anesthetic blood panel will be done to evaluate any major organ functions prior to anesthesia.

Anesthesia/Surgical Consent Form - Petsville Animal Hospital