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Pre-Surgical Consent Form
Like you, our greatest concern is the wellbeing of your pet. Before putting your pet under anesthesia, we will perform a full physical examination. However, many conditions including disorders of the kidneys or liver, diabetes, or dehydration are not detected unless blood testing is performed. Our modern, in-house laboratory equipment allows us to perform the preanesthetic blood profile prior to the anesthesia event. The cost of the preanesthetic profile is $40.00.
Pre-anesthetic profile
YES, I want my pet to have the pre-anesthetic profile.
NO, I decline the pre-anesthetic profile.
For CATS, we also recommend a FeLV/FIV combo test to screen cats for feline leukemia virus and FIV(AIDS); which are both highly contagious and terminal diseases. The cost for the combo test is $40.00.
YES, check my cat for FeLV/FIV
NO, do not check my cat for FeLV/FIV
For DOGS, we strongly recommend a heartworm test unless your dog is current on an annual heartworm test and heartworm preventative. The cost for the heartworm test is $38.50.
YES, check my dog for heartworms.
NO, do not check my dog for heartworms.
Our pets do not show pain as we do. They do not complain as loudly as we do and they accept the levels of pain that we could not imagine. Pets recover quicker and with fewer complications with appropriate pain management. The cost of post-op pain medications are:
LESS THAN 50 POUNDS: $14.50
50 TO 100 POUNDS: $19.50
OVER 100 POUNDS: $24.50
Post-Operative Pain Management
YES, prescribe post-operative pain medications.
NO, do not prescribe post-operative pain medications.
In the event of an emergency, a pre-place intravenous catheter allows more rapid administration of potentially lifesaving medications. The cost to place a catheter is $40.00.
YES, place an intravenous catheter prior to surgery
NO, do not place IV catheter prior to surgery
Microchipping greatly increases the chance of finding your pet should it ever be lost. If your pet is not microchipped, the HomeAgain Microchip can be implanted pain free at the time of surgery at a cost of $40.00.
YES, implant a microchip at time of surgery.
NO, do not implant microchip at time of surgery
Procedures requiring anesthesia are always associated with a certain amount of risk, whether the patient is a person or a pet. Like you, we want to minimize that risk as much as possible. By signing below, you acknowledge that you understand the nature of the procedure(s) being performed, that any questions you have concerning the procedure(s) have been answered, and no guarantee has been made as to the results or cure and that you understand that there may be risks involved in these procedures. These complications include (but certainly are not limited to):
Infection(s)
Internal organ damage from idiosyncratic reaction or changes in blood flow to those organs
Arrhythmias
Reactions from interaction with other current medications
Aspiration of gastric contents with possible aspiration pneumonia
Irritation, inflammation or tear of the trachea due to placement of endotracheal tube during anesthesia
Hypertension or hypotension from length of procedure or medication effect on body systems
Allergic reaction to medications
Brain trauma (temporary or permanent) from changes in blood flow to brain during procedure
Thromboembolic event (stroke, hypercoagulation disorders, etc.)
Malignant hyperthermia
Malfunction/slippage of sutures/ligatures/staples (internal or external)
Dehiscence of incisions/closures and associated complications
Death
All charges are due and payable upon the pet’s release. Brown Creek Animal Hospital, PA is not responsible for any personal items such as towels, blankets, toys, etc. left with your pet during its stay. I hereby consent and authorize Brown Creek Animal Hospital to receive, prescribe for, treat, or operate upon my animal(s). Brown Creek Animal Hospital is to use all reasonable precautions against injury, escape, destruction of the animal(s), but you will not be held liable or responsible in any manner whatever, or any circumstances, on account of the care, treatment, or safekeeping of the animal(s), as it is thoroughly understood that I assume all risks. I also understand that Brown Creek Animal Hospital is not staffed twenty-four (24) hours a day and after hour treatment of patients is at the discretion of the veterinarian and owner.
Animal(s)
Procedure(s)
Owner Signature
First
Last
Date
MM
DD
YYYY
Please provide a contact phone number
New Clients
What To Expect
Take A Tour
Make an Appointment
New Client Registration Form
About Us
Our History
Location & Hours
Our Team
Pet Services
Alternative and Complementary Therapy
Anesthesia and Patient Monitoring
Medical Services
Nutritional Counseling
Preventive Services
Surgical Services
Wellness and Vaccination Programs
Additional Services
Advanced Treatments
Pet Health
Pet Health Library
Pet Health Checker
Pet Insurance
Pet Food Recalls
Product Recalls
How-To Videos
News
Online Pharmacy