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Surgical Consent Form

(To print, click on the Print Page button on the lower left corner of the website page) 

Your dog or cat should not have any food or water after midnight the night before surgery (this is not relevant for exotics)

_____ My pet hasn’t had any food or water since midnight.

It is important that we be able to reach you today, if needed.
Phone numbers:_________________________

Is your pet receiving any supplements?______________________________________________

All pets undergoing surgery at Olive Branch Parke Veterinary Clinic are required to have presurgical blood work testing. This will check for pre-existing medical conditions which may increase the risk of complications during surgery.
Olive Branch Parke Veterinary Clinic uses sevoflurane gas which is the most recent and safe gas anesthetic available in veterinary medicine and is the same anesthetic gas used for many human procedures.
Olive Branch Parke Veterinary Clinic uses state-of-the-art surgical monitoring equipment to monitor your pet’s blood pressure, temperature, heart rate and rhythm during surgery.
Olive Branch Parke Veterinary Clinic provides pain medication for pets before, during, and after surgical procedures.
Olive Branch Parke Veterinary Clinic will place an intravenous catheter to administer fluids while under anesthesia. IV fluids will aide the body in stabilizing internal organs and blood pressure, and aid in metabolizing the anesthesia more efficiently.    Along with shaving the hair at the IV catheter site, we may also shave other areas including the surgical site for surgical prepping and cleansing and also the monitor sites so they will function properly.

All pets presented for surgery must be free of external parasites. If fleas, ticks, or ear mites are found, the pets will be treated for these parasites at the owner’s expense.

If a dental cleaning is being performed, teeth that are badly damaged by dental disease, may be pulled.

Pets presented for surgery must be current on vaccinations and heartworm test and cats must have had a negative Feline Leukemia test.

Please note that Olive Branch Parke Veterinary Clinic has business, medical, and staffing hours Monday through Friday 8:30-5:30. We are closed Saturdays, Sundays and holidays. Therefore, this is to inform you that we have no in-house continuous medical staff care overnight after closing time, weekends or on holidays.  We provide weekday and holiday care on a regular, but intermittent basis only.

If your pet has not already been microchipped, would you like us to do that while s/he is under anesthesia?
_____Yes _____No

To ensure that your pet will not chew or lick open the surgical site, an Elizabethan collar is available. This small investment could save you the added cost to have the site repaired.
_____Yes _____No, I understand the risk.

Has your pet recently experienced vomiting, diarrhea, coughing or sneezing?
_____Yes _____No

Is your pet allergic to any drugs? If so, please list

Has your pet had any history of seizures or problems under anesthesia?
_____Yes _____No

I understand that all anesthesia involves some minimal risk to my pet and therefore the assistants and/or doctors will not be held liable or responsible in any manner for the injury, escape or death of my pet in connection with the procedure. I am encouraged to discuss any concerns I have about those risks with the veterinarian before the procedure(s) is/are initiated. I agree to pay in full for the services rendered.
Signed___________________________________________ Date__________