Surgery Consent Form

Please Note: : For the comfort and care of all our patients, any pet that is admitted into our clinic with fleas &/or ticks will be treated
at the owner’s expense. All dogs undergoing anesthesia must show proof of a negative heartworm test within one (1) year.I understand that the doctors and staff of Cypress Falls Animal Hospital will take every precaution to prevent this pet’s exposure to
any infectious diseases, but I recognize the risks associated with dropping off this pet in that he/she may be remotely exposed. I am aware that I am responsible for any expenses incurred resulting from illnesses this pet develops during his/her stay at Cypress Falls
Animal Hospital. All pets without proof of current vaccines at time of admission will be vaccinated per hospital policy at owner’s
expense.

I understand that there is some risk involved with the use of sedatives and general anesthesia, up to and including death. I
understand that unexpected circumstances may result from the above procedure(s). If unforeseen conditions should arise, I hereby
authorize the veterinarian to expedite the necessary measures to correct these conditions.

Please choose and initial the following options.(*Additonal cost based on patient size)

Bloodwork – To aid in detection of unforeseen medical conditions, we recommend bloodwork prior to sedation or anesthesia. This
may affect the doctor’s decisions concerning anesthetic protocol

Supportive Fluids – An IV catheter will be placed in your pet, which requires a small area of fur to be shaved on the patient’s leg.
We strongly recommend supportive fluid therapy through this intravenous catheter in all patients to maintain blood pressure and
tissue perfusion throughout general anesthesia. This speeds recovery time and is especially important in senior patients.

Pain Management: – I understand that pain medication might be administered in the form of injection, oral liquid or tablet to provide
perioperative or post-operative pain management and minimize inflammation at the surgery site.

Microchip – If your pet is not already microchipped, we can implant a small microchip for permanent identification while your pet is
under anesthesia.

Miscellaneous – Many pets exhibit anxiety during routine hygienic procedures. If you prefer, we can perform the following
procedures on your pet while under anesthesia. (Please initial your choices, if any, below)

Dental Options – Because your pet will already be anesthetized, a dental cleaning and/or fluoride treatment can be done. If your
pet’s teeth do not need cleaning, we recommend a fluoride treatment to help prevent tooth decay and strengthen tooth enamel.

I have read the above standard consent form and authorized the veterinarian to perform the indicated procedures. I understand
that I may request an estimate of procedures before they are preformed and payment is due in full at the time my pet is
discharged from the hospital.