SURGICAL CONSENT FOR SENIOR ELECTIVE SURGERY

(Spay, Neuter, Etc. for Animals Over 6)

Owner:______________________________ Pet:______________________________ Age:______

I certify that I own or am an agent for the owner of the above described animal. I hereby authorize the Doctors at Sugar Creek Animal Hospital and whomever they may designate as associates or assistants to anesthetize this pet and perform the following procedures:

Procedures Scheduled:______________________________________________________________

If an unforeseen condition arises calling for, in the doctor’s judgment, procedures in addition to or different from those now contemplated, I further request and authorize the doctor to do whatever he deems advisable. I agree to pay, in full, for all medical services rendered, including those deemed necessary for medical or surgical complications or otherwise unforeseen circumstances. I understand that every effort will be made to notify me prior to additional treatment for non-emergency conditions.

The nature and purposes of the procedures, the risks involved and possibility of complications have been explained to me to my satisfaction. I realize that no guarantee nor warranty can ethically or professionally be made regarding the results, or cure. I understand that there is always a risk involved with anesthetic or surgical procedure and I accept these risks.

Signature:___________________________________________________ Date:____________________

PRE-ANESTHETIC TESTING

Like you, our greatest concern is the well-being of your pet. Before anesthetizing your pet, we will perform a full physical examination. However, many conditions, including disorders of the liver, kidneys, heart or blood, are not detected unless testing is performed. Such tests are especially important before any kind of surgery.

Prior to anesthesia, the Doctors of Sugar Creek Animal Hospital require certain blood tests be performed that may help detect any underlying abnormalities associated with your pet’s health. In the event that abnormalities are found, it is possible that the Doctors may elect to postpone anesthesia based on certain problems with the blood work.

For these reasons, we require PRE-ANESTHETIC screening which includes a CBC & MINI CHEM PANEL. The SENIOR SURGERY TESTING is $77.00.

Our lab is equipped to run these tests and the information will be available before anesthesia and/or surgery.

A microchip can be implanted in your pet while under anesthesia for $41.00.

___YES, I want my pet to be micro chipped while under anesthesia.

___NO, I do not want my pet to be micro chipped.

**Your pet must be free of internal or external parasites or they will be treated at the owner’s expense.**

Signature:___________________________________________________ Date:____________________

Phone number where we can reach you today:______________________________