Please fill out the following form as thoroughly as possible before your scheduled appointment.
Please read carefully before you sign:
Your pet will require anesthesia for the above elected procedure. We recommend a blood profile to assess and minimize the risk of anesthesia for your pet, and check your pet's health. The latest technology enables us to run safe, and accurate blood chemistries, minutes before anesthetic induction. These tests are similar to those your physician would run if you were undergoing anesthesia. Results will also serve as future reference values should your pet become ill.
I understand that if my pet is in heat, or pregnant, there will be an additional charge due to increased complexity of surgery. I give my permission to proceed with surgery having been made aware of the additional estimated starting cost:
Canines (based on weight in pounds):
(<15# = $120.00) (15-40# = $135.00) (41-75# = $150.00) (76-100# = $172.50) (>100# = $235.00)
I authorize anesthesia/surgery for my pet. The nature and risks of this procedure(s) have been explained to me. I understand that some risks always exist with anesthesia and/or surgery, and I am encouraged to discuss any concerns I have about those risks with my veterinarian before the procedures(s) are initiated. My signature on this consent form indicates that any questions have been answered to my satisfaction.
I authorize Cobb Veterinary Clinic, P.C. to perform any additional diagnostic, treatment, or surgical procedure(s) deemed necessary for medical or surgical complications or otherwise unforeseen circumstances. While Cobb Veterinary Clinic, P.C. provides the highest quality of anesthesia monitoring and surgical services, I understand that there are rare complications associated with any anesthetic or surgical procedure. No warranty or guarantee has been given to me as to the results or cure afforded by these treatments or procedures.
I fully understand these risks and understand that the veterinarians and hospital staff will try to minimize such risks. I will not hold Cobb Veterinary Clinic, P.C., the veterinarians, or any staff member liable for any complications that may arise.
I HAVE READ AND FULLY UNDERSTAND THIS SURGERY AND ANESTHESIA CONSENT FORM.