Safety, Comfort, and Laser Consent Form

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Pre-Anesthesia Tests

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

For these reasons, we highly recommend pre-anesthetic blood screening before such procedures. The total costs of these important tests will be discussed on the day of hospital admission.

Patients under 7 years - PreOp package - young.

Patients over 7 years (if done 1-5 days prior to day of surgery)- PreOp - older

Patients over 7 years (if done morning of surgery) - PreOp - older

Our laboratory is fully equipped and staffed to perform these important blood tests for the safety of your pet. Results will be immediately available for us to examine before anesthesia and surgery. If there are abnormal values, they will be discussed with you before anesthesia.

Please indicate your choice below:

p YES, I want my pet to have a pre-anesthetic testing.

p NO, I decline the recommended pre-anesthetic tests at this time and request you proceed with anesthesia. I understand that a medical condition may exist which would be impossible to identify during a physical exam alone. I understand that my pet's health could be at risk if such a condition goes undetected when he or she is placed under anesthesia.

Electronic Monitoring During Anesthesia =

Our hospital can monitor internal temperature, heart rate, and the amount of oxygen in your pet's blood stream on a continual basis during anesthesia. We recommend every dog and cat get "EM" during their procedure. This allows us to see your pet's vital signs every minute of the procedure.

= Required for all anesthesia.

Post Surgical Pain Management

Sometimes after surgery, your pet will experience some pain, usually upon coming out of anesthesia. If you would like us to administer pain medication to your pet in order to alleviate pain after surgery, please check the "yes" box.

There is a charge for this medication, which is based on the weight of your pet and the intensity of the pain.

p YES, I want my pet to have pain medication, if needed.

p NO, I do not want my pet to have any pain medication under any circumstances.

Laser Surgery Consent

As part of our commitment to quality care, we are pleased to offer laser surgery as an option for safe, comfortable treatment for your pet. We feel that laser surgery provides the best possible care for your pet.

The benefits of laser surgery are:

Less Pain – the laser seals nerve endings as it “cuts”, so your pet may require fewer anesthetics during the operation, also reducing pain after the surgery.

Less Bleeding – the laser seals small blood vessels during the surgery, greatly reducing blood loss.

Less Swelling – the laser energy does not crush, tear, or bruise the tissue because there is no physical contact with the tissue.

Your pet will be treated with a carbon dioxide laser, which produces an invisible beam of light that can remove a precise layer of tissue at one time. This can reduce your pet’s post-operative recovery time, leading to a quicker return to normal activities.

I understand that laser surgery is an option and I have been advised of the advantages the procedure will offer.

_____ Yes, I want my pet to have laser surgery and understand the costs listed below are in addition to normal surgery costs.

Examples: Your pet may fit into a different Level.

· Level I: (spays, neuters, minor skin lesions such as warts, etc.)

· Level II: (oral surgery, eyelid repair, etc.)

· Level III: (declaws, internal incisions)

· Level IV: ( larger tumor removals, etc.)

· Level V: (mammary tumors, cosmetic procedures, soft palate, etc.)

_____ No, I decline laser surgery for my pet.

Additional Requests After Surgery: To further prevent licking, chewing, or biting the incision:

I wish to have my pet fitted for an E-Collar oyes oNo, declined.

I wish to have my pet sent home with additional pain medication oyes oNo, declined.

I wish to have a body bandage applied to my pet after surgery oyes o No, declined

I have read the above carefully and if I decide to decline the Pre-Anesthesia Tests and/or Electronic Monitoring During Anesthesia, I know and accept the added risk for my pet.

The above form must be filled out completely before surgery is started.

Pet's Name: Owner's Name:

Signature: _________________________ Date:

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