Surgical and Anesthesia Consent Form

Owner's Name____________________________Pet's Name________________Weight______

Procedure______________________________________________________________________

I hereby authorize and direct the veterinarians of Archer Animal Hospital to perform the above listed procedure(s) and/or treatment(s) as deemed advisable or necessary for my pet. The nature of the procedure(s) has been explained to me. No guarantee has been made as to the results or cure. I am aware and understand there are risks involved in these procedure(s) and/or treatment(s). Potential risks are: infection, tissues not healing, pain, drug reaction, digestive problems, and death.

I agree to pay in full for the services rendered, including those deemed necessary for medical or surgical complications and/or unforeseen circumstances. Any estimate of fees for presently planned procedures is only an approximation, and the final bill may be more or less than this amount. We will attempt to contact you if any cost changes are recommended. We are a flea and tick free facility!  Upon admission, if a pet has internal or external parasites, they will be treated at the owner's expense.

ALL SERVICE RENDERED MUST BE PAID IN FULL BEFORE THE PET CAN BE RELEASED FROM THE HOSPITAL

Services

A pre-anesthetic examination is recommended for all pets. The cost is $37.24.

I accept a pre-anesthetic exam for my pet_____________________________

Research has shown pain management is very important in your pet's recovery from surgery. Archer Animal Hospital supports therapeutic pain management for all surgery patients. We will administer pain medication to your pet before and after surgery unless otherwise indicated by you. The cost for cats is $52.50.

I accept pain medication for my pet___________________________________

Many of the drugs used in anesthesia are removed from the body by the liver and kidneys. The doctors firmly believe it is important to know how these organs are working before administering any drugs. Since organ function is negatively affected by age, older pets require more extensive testing. The costs are as follows:

8 weeks to 2 years -- PCV, Total Protein, BUN -- $34.62 (unless quoted otherwise)

3 years to 5 years -- CBC (Complete Blood Count), mini panel -- $74.93 (unless quoted otherwise)

6 years or older -- CBC (Complete Blood Count), chemistry panel -- $103.61 (unless quoted otherwise)

I accept blood work for my pet________________________________________

Intravenous fluids provide support to the heart, lungs, and kidneys during anesthesia. The doctor will place an intravenous catheter into your pet's vein to provide access for fluids to be given and to administer life saving drugs in the case of an emergency. The cost for this procedure is $47.00.

I accept an IV catheter and fluids for my pet_____________________________

We highly recommend an Elizabethan collar after surgery. The cost ranges from $10-$20.

I accept an E-collar_______________________________

We can implant a microchip while under anesthesia for $35.00

I accept a microchip_______________________________

Signature of Owner or Responsible Agent________________________________________

Date___________________ Contact and Emergency Phone Number(s)

Estimated Amount $_______________