Anesthetic Consent Form "*" indicates required fields Your Name* First Last Consent for TreatmentI, the undersigned, certify that I am the owner or the authorized agent for the owner of the animal described above, and I have the authority to execute this consent. My signature below certifies that I am over eighteen years of age.* I am the owner or the authorized agent Be assured that the health of your pet is our highest priority, and we will do everything possible to maintain that health. Understand, too, that your signature below indicates that you have reviewed and agree to the terms of the financial estimate. By signing, you acknowledge responsibility for the charges of services that are provided to your pet. We will make reasonable efforts to contact you to discuss additional fees that may be incurred during your pet’s stay.* I understand I understand that risks always exist with anesthesia and/or surgery and that I am encouraged to discuss any concerns I have about risks with the attending veterinarian before the procedure is initiated. My signature on this form indicates that any questions I have regarding the following issues have been answered to my satisfaction. Some questions that I may have may include but are not limited to: Reasonable medical and/or surgical treatment options for my pet Sufficient details of procedures to understand what will be performed How fully my pet will recover and how long it may take The most common and serious complications that may occur Length and type of follow up home care, home restraint that may be required, and the use of hard-shelled buster collars to prevent self- induced trauma The estimate of all fees for all services Any necessary payment arrangements I understand that risks always exist with anesthesia and/or surgery and that I am encouraged to discuss any concerns I have about risks with the attending veterinarian before the procedure is initiated. My signature on this form indicates that any questions I have regarding the following issues have been answered to my satisfaction* I understand While Helping Paws Animal Hospital doctors and staff make every effort to mitigate serious complications and keep your pet safe, I understand the risk of complications exist, including the risk of death.* I understand In addition, I acknowledge the following: Every surgery runs the risk of having complications. In the event of a complication, you, as the owner, are financially responsible for fees incurred. If I choose to take my pet to another facility for any follow-up, for any reason, including complications from any procedure done at Helping Paws Animal Hospital, I, the owner, am responsible for all fees incurred. I understand that Helping Paws Animal Hospitals is not a 24-hour staffed facility. If my pet undergoes an overnight stay, I am aware that I have the option to take my pet to a 24-hour staffed facility. I approve of any text messaging/photos during my pets stay for communication and medical updates. I understand and agree that for an ovariohysterectomy (spay) surgery, the uterus and ovaries are removed. If the uterus is carrying developing young, the developing embryos are removed along with the uterus and the pregnancy is terminated. The female cannot become pregnant again. Additional fees will be incurred. In addition, I acknowledge the following: • Every surgery runs the risk of having complications. In the event of a complication, you, as the owner, are financially responsible for fees incurred, • If I choose to take my pet to another facility for any follow-up, for any reason, including complications from any procedure done at Helping Paws Animal Hospital, I, the owner, am responsible for all fees incurred, • I understand that Helping Paws Animal Hospitals is not a 24-hour staffed facility. If my pet undergoes an overnight stay, I am aware that I have the option to take my pet to a 24-hour staffed facility, • I approve of any text messaging/photos during my pets stay for communication and medical updates, • I understand and agree that for an ovariohysterectomy (spay) surgery, the uterus and ovaries are removed. If the uterus is carrying developing young, the developing embryos are removed along with the uterus and the pregnancy is terminated. The female cannot become pregnant again. Additional fees will be incurred.* I understand I have read and understand* I have read and understand all the above and have been informed about my pets procedures and give my consent to proceed. CPR StatementPlease choose:* DO NOT RESUSCITATE: In the event my pet’s heart and/or breathing stop, I request no person to attempt resuscitation of my pet. BASIC CARDIOPULMONARY RESUSCITATION: I request the doctor(s) and staff attempt to resuscitate my pet through utilization of artificial respiration and/or heart compression, as well as administration of various emergency medications and/or fluids as deemed necessary and/or appropriate by the attending veterinarian. I understand that there is no guarantee in the success of these efforts and that my pet may die despite CPR. The cost of CPR is $300.00 If unexpected life-saving emergency care is required, and the hospital is unable to contact me, Helping Paws Animal Hospital will provide such treatment, and I agree to pay for such services unless otherwise specified in this agreement.* I agree The nature of these operations or procedures has been explained to me, and I understand what will be done. I am aware that the practice of veterinary medicine is not an exact science and, thus, there are no guarantees for successful treatment. I have been encouraged and given the opportunity to discuss any questions I may have regarding my pet's medical care, and my questions have been answered to my satisfaction. I accept that my financial obligations remain regardless of the outcome.* I understand I have read and understand* I have read and understand all the above and have been informed about my pets procedures and give my consent to proceed. Signature*Date* MM slash DD slash YYYY CAPTCHA Δ
