Client Name *

Pet Name *

Procedure(s) to be performed: *

Has your pet had any food or water since 10pm last night? *

Has your pet been coughing, wheezing or breathing hard? *

Has you pet been vomiting or having diarrhea? *

Do you want your pet Microchipped? ($54.00) *

Has your pet ever had an allergic or adverse reaction to a medication? *

Is your pet taking any medications? *

PREANESTHETIC TESTING: Your pet is being admitted for surgery today. Your veterinarian will perform a physical exam, checking the heart, lungs, mucous membranes, teeth, eyes, ears, skin and lymph nodes. However, some conditions and illnesses cannot be detected during a physical exam. In order to make sedation/anesthesia as safe as possible, our doctors require that all pets have pre-anesthetic blood tests and an EKG to help identify any potential problems. This information is not only useful for today’s procedure, but will serve as a reference value for the future. State-of-the-art technology allows us to run safe, accurate blood counts and chemistries minutes before anesthetic induction. If not previously done, your pet’s doctor will determine the appropriate blood tests needed for anesthetic safety and wellness.

REQUIRED TREATMENTS: All pets admitted to Okatie Veterinary Center must meet our requirements for minimum acceptable vaccination and must be free of external parasites. Any animal that requires vaccinations or is found to have fleas or ticks will be treated after discussion at the owner’s expense. All patients receiving sedation or anesthesia will receive an ear exam and nail trim at no charge. However, if an ear infection or foreign body is found, appropriate treatment will be discussed.

ANESTHETIC MONITORING: We strive to maintain the highest standard of anesthetic safety and patient care. All of our patients receive sophisticated monitoring systems (EKG, doppler blood pressure, capnagraph and pulse oximetry) during the procedure. Your pet will be closely monitored by one of our caring, highly trained anesthesia technicians working closely with the doctor for the best anesthetic outcome. With this, the risks of anesthesia are significantly minimized but not completely eliminated. Please ask your veterinarian if you have any concerns regarding anesthesia for your pet.

PAIN MANAGEMENT: We recognize that pets recovering from surgery feel pain and stress. Your pet will be given appropriate analgesic (pain relieving) injections and/or oral medications to keep them comfortable following surgery. They will be recovered in a warm, padded cage under the watchful eye of our staff members, and will most likely be able to return home later today. An additional therapy we offer for pain management is Laser Therapy. ($25.00)

Would you like your pet to receive Laser Treatment post procedure? *

DENTISTRY (only): If your pet is having a dental procedure, we will perform a complete oral exam and dental assessment while your pet is under anesthesia. We may identify additional problems during the dental procedure that could not be identified beforehand, such as broken or abscessed teeth, bone loss, deep pocketing, etc. These problems are best dealt with while your pet is under anesthesia.

Please indicate how you would like for us to proceed if additional procedures not previously discussed are warranted: *

I authorize the veterinarian to proceed with any necessary treatment for my pet.
I do not authorize the veterinarian to proceed with additional treatment without my consent. I understand if I am unable to be reached by phone, my pet will be recovered from anesthesia and an additional anesthetic procedure will be needed to correct the problem, which will be at an additional cost.

AUTHORIZATION and CONSENT: I authorize the use of anesthesia and other medications as deemed necessary by the veterinarian and understand that the hospital personnel will be employed in the procedure as directed by the veterinarian. I have been advised as to the nature of this procedure to be performed and the risks involved. No guarantees have been made regarding the outcome or cure. I understand that there is always a risk associated with any anesthesia episode, even in apparently healthy animals, and have discussed my concerns. I have been provided the opportunity to ask questions and receive answers regarding the procedure. I fully understand the risks involved and realize that results cannot be guaranteed. I understand that it may be necessary to provide medical and/or surgical procedures which are not anticipated for the safety or care of my pet. I hereby consent to and authorize the performance of such altered and/or additional procedures as are necessary in the veterinarian’s professional judgement. I accept responsibility for any result in additional charges. I authorize Okatie Veterinary Center to perform the listed procedure(s). I am the owner (or agent for the owner) and have full authority to execute this consent. I agree to be responsible for all charges incurred while my pet is in the care of this facility and understand payment is due at the time my pet is released from the hospital.

I have read and understand the information printed above (pages 1 and 2).

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Please list any personal belongings you are leaving with your pet today so we may be sure to return them to you upon dismissal:

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