Surgery Anesthetic Procedure Authorization - Vet In Austin

Client Name*

Pets Name*

Primary Contact Number*

Secondary Contact Number

Procedure(s) to be performed*

Time*

We will call you after your pet's procedure to schedule a pick-up time.What time are you available to pick up your pet today?(your pet may not be ready to go home by this time).

:

I, the undersigned owner or agent of the owner of the pet identified above, certify that I am of eighteen years of age or over and authorize the veterinarian(s) at this practice to perform the above procedure(s). I understand that some risks always exist with anesthesia and/or surgery and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure(s) is/are initiated. My signature on this form indicates 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 procedures to understand what will be performed
How fully my pet will recover and how long it will take
The most common and serious complications
The length and type of follow-up care and home restraint required
The estimate of the fees for all services
Any necessary payment arrangements

While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that veterinary medicine is not an exact science and that no guarantee or warranty has been made regarding the results that may be achieved. I agree to pay the estimated fees, assume financial responsibility for the remaining fees, and provide payment in full at the time my pet is discharged from the hospital.

Should an unexpected critical situation arise (choose one):*

I authorize and accept financial responsibility for the veterinarian(s) and staff to perform lifesaving procedures.
I choose that the veterinarian(s) and staff DO NOT resuscitate my pet.

Did your pet take medications in the last 24 hours?*

Yes
No

Describe Medication

Medication

Strength

Time Given

Blood Testing For Pets Under 6* years old*

Pre-anesthetic blood tests help ensure your pet’s liver and kidneys are working well, and ensure they have the appropriate levels of red blood cells, blood proteins, and blood sugar. Each of these things are important while under anesthesia. It is uncommon for younger pets to have issues with these parameters, but pre-anesthetic blood testing is the only way to be certain. *Changes on blood tests are more common in older pets, pets over 6 years old are required to have pre-anesthetic blood tests. Would you like to have pre-anesthetic blood tests performed today?

I would like to have pre-anesthetic blood tests performed as part of my pet's procedure.
I do not want to have pre-anesthetic blood tests performed as part of my pet's procedure.
My pet has already had pre-anesthetic blood tests performed in the last 3 months.

Date*

Signature*

Email*

Phone

This field is for validation purposes and should be left unchanged.

Surgery – Anesthetic Procedure Authorization