Owner's Name *

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Owner's Email *

Pet’s Name(s):

Procedure:

Hobart Animal Clinic Surgical Consent and Options

Like you, our greatest concern is the well-being of your pet. Many conditions, including disorders of the liver, kidneys, and blood are not detectable with a simple physical examination. Consequently, we recommend a blood test that we will perform before your pet goes under anesthesia. The additional cost of this test is $79.25

In animals undergoing extensive surgery or animals that are considered elderly/geriatric intravenous catheters with fluids (IV’s) are recommended. The primary reasoning for this is safety and to decrease risk. IV's help maintain your pet’s blood pressure during procedures and the catheter allows the doctor direct access to a vein in an emergency situation. If there would be a problem during the procedure, we would be more readily prepared to address that problem (with medications, fluids, etc.). The additional cost of the intravenous fluids and catheter is $97.50

There are many ways to identify lost or stolen pets. The most accurate way is a “microchip”. The microchip is implanted under your pet's skin and stays with your pet for his/her entire life. If your pet is ever lost, virtually all animal clinics and shelters check recently found pets for a microchip in order to return the pets to their home. The additional cost of the microchip is $77.75

Heartworm Disease is a serious, potentially fatal illness transmitted to dogs by infected mosquitoes. We recommend heartworm preventative to be given year-round. We now offer a 6-month or 12-month heartworm injection. With one injection, ProHeart 6 or 12 protects dogs from heartworm infection for a full 6 or 12 months. The cost of this injection depends on the weight of your pet.

PRE-OPERATIVE BLOODWORK ($79.25) *

Yes
No

INTRAVENOUS FLUIDS ($97.50) *

Yes
No

MICROCHIP ($77.75) *

Yes
No

PROHEART 6 INJECTION (Canine Only)

Yes
No

PROHEART 12 INJECTION (Canine Only)

Yes
No

*IV Fluids required for certain procedures

NOTE: THESE SERVICES ARE IN ADDITION TO YOUR PET’S BASIC PROCEDURE AND WILL BE ADDED TO THE PRICE YOU WERE QUOTED FOR THE PROCEDURE TO BE PERFORMED TODAY.

I hereby authorize Hobart Animal Clinic/Crossroads Animal Hospital, the Doctor(s) its employees, representatives, or agents, to medicate, test, sedate, anesthetize, and operate upon the above animal as they deem necessary for the health, safety, or well being of the above animal. I understand that all reasonable precautions against injury, escape, or death of the above animal will be used however, I acknowledge that certain inherent risks are involved in the carrying out of any of the medical procedures or handling of an animal that are beyond the control of the persons(s) involved. In the absence of gross negligence. I thoroughly understand that I assume certain risks and will not hold Hobart Animal Clinic/Crossroads Animal Hospital, the Doctors; it’s employees, representatives, or agents liable or responsible in any manner of circumstance for these risks. *

I agree

Signed: *

Clear Signature

Date: *

Preferred contact method for today:

Text
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Surgical Consent Form – Hobart Animal Clinic

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Please note- Payment is due in full when you pick up your pet.

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