Surgery Consent Form


  • As the owner, or authorized agent of the above named animal, I hereby consent and authorize the clinic to receive, prescribe, treat, or operate on this animal. The nature of the procedures has been explained to me and no guarantee has been made as to the results or cure. I understand that the clinic staff & doctors will make every effort they possibly can to minimize the risk associated with general anesthesia & the services to be performed, but all risks will be assumed by me.

  • 1. Rabies - vaccination is required for pets 14 weeks and older.
    2. Fasting - I certify that the above animal has not been fed since last evening.
    3. After hours care -I understand that no one is on the premises after hours.
  • Your pet may be given both a pain & antibiotic slow release injection at the time of the procedure. These injections will last for 24 hours. The cost of these injections are not covered by the rescue.
  • Your pet may be sent home with a course of post-operative antibiotics. An extended-release antibiotic injection, Convenia, is available if you believe he/she would be difficult to orally medicate.
  • Before putting your pet under anesthesia, we will perform a full physical examination. We highly recommend that a pre-anesthetic blood profile be performed to check the health of your pet's organs. At-risk medical conditions may not be detected without a pre-anesthetic blood profile. Please Note: The pre-anesthetic panel is MANDATORY for pets ages 5 years and older
  • An intravenous catheter (IV), or SQ fluid therapy is recommended for anesthesia safety. An IV gives direct access to the veins in the event of a crisis. Fluid therapy / IV will maintain normal blood pressure, providing vital movement of blood to important organs such as the heart, brain, kidneys, liver and lungs. Please Note: IV Fluids is MANDATORY for pets ages 5 years and older.
  • E-Collar - The use of an e-collar is HIGHLY recommended after surgery. E-collars help keep your pet from licking and chewing at the surgical incision site. In the event your pet removes their sutures and the incision opens, an additional charge would apply to repair the surgery site. You may choose to purchase an e-collar from us. Sizes vary as does cost ($14.00 - $20.00)
  • In the event my pet goes into cardiac/ respiratory arrest (heart stops/ stops breathing) I give permission for American Veterinary Hospital to perform CPR and other lifesaving measures. Costs of these services can run up to $250.00 and are not reflected in prior estimates.
  • Date Format: MM slash DD slash YYYY