Animal House Veterinary Hospital

4202 JEFFCO BLVD
ARNOLD, MO 63010

(636)464-1038

www.animalhousevetstl.com

Anesthesia and Surgical Consent Form

Please print and fill out or you can fill the form out online to submit it.  If printed, please bring with you the day of your pet's scheduled surgery.

Any questions, call us at (636) 464-1038

Surgery Consent Form Form

Owner/Agent (required)

Patient (required)

Procedure (required)

General Anesthesia - Please Read
General anesthesia has become safer in recent years with the advent of newer drugs and better patient monitoring. Some conditions, however, may not be evident on physical examination alone. To better ensure your pet's safety under anesthesia, we advise that the following precautions be taken, even for elective procedures.
IV Catheter and Fluids
Intravenous fluids given during anesthesia and/or surgery help to maintain blood pressure and allow rapid administration of drugs should an emergency situation develop. If your pet is 8 years old or over, an IV catheter and fluids are mandatory and included in the estimate. If your pet is less than 8 years old and choose to accept there is an additional charge of $30.00
Accept or Decline IV Catheter and Fluids? (required)
Accept
Decline
Pre-Anesthesia Blood Testing:
We recommend pre-anesthetic blood work prior to all anesthetic procedures. A physical examination alone cannot detect all underlying medical problems that may complicate any anesthetic events. Blood work allows us greater information regarding your pet's major organ systems such as the liver, kidney, red and white blood cell counts as well as an electrolyte balance. A comprehensive blood panel is mandatory for all pets 8 years or over and is included in the estimate. The blood panel is still recommended for all other patients under the age of 8 years old. The cost when included with a procedure is $89.00
Accept or Decline Pre-Anesthesia Blood Testing? (required)
Accept
Decline
Microchipping:
We recommend that all patients have a microchip implanted for permanent identification in case pets are lost or stolen. The cost for this is $60.50. If your pet is not already microchipped, would you like to implant one today during their procedure?
Accept or Decline Microchipping? (required)
Accept
Decline
E-Collar
We recommend sending home an e-collar after surgery. This will help prevent your pet from reaching their surgery incision which can prevent additional post-op problems and costs such as incision repair. The cost of the e-collar is $16.00. Would you like us to send you home with an e-collar for your pet after surgery?
Accept or Decline E-Collar? (required)
Accept
Decline
Authorization to perform anesthesia and surgical procedures/treatments:
I hereby authorize Animal House Veterinary Hospital to perform such diagnostic, therapeutic anesthetic and surgical procedures as above. The nature of such services has been described to me and to my satisfaction and I realize that no guarantee or warranty can ethically be made regarding the results or cure. I authorize the hospital staff in an emergency situation to follow through with such procedures as necessary for the well-being of my pet and continuing basis until further communication with me. I understand that I will assume financial responsibility for the services rendered. *If a dental procedure is being performed and extractions are necessary, I give authorization to complete the procedures.
By clicking agree as the owner/agent, you are electronically signing this authorization form: (required)
Agree
Disagree
Emergency Contact where we can reach you: (required)


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