Arden Animal Hospital

1823 Fulton Avenue
Sacramento, CA 95825

(916)485-5412

ardenanimalhospital.com

Anesthesia Consent Form

Client Name (required)
First Name (required)
Last Name (required)
Pet's Name (required)

Procedure to be performed (required)

Please read:
Your pet will be undergoing a procedure requiring general anesthesia today. By signing this form you understand that there are risks inherent to any anesthetic procedure, which may include death. If you have additional concerns about these risks that you feel have not been addressed, please address these with the attending doctor before the treatment is initiated. Your pet’s safety is our primary concern and the following options are protocols that we recommend in order to reduce the risk of anesthesia.
I have been given a copy of an estimate and understand the charges (required)
Yes
No


Pre-Anesthetic Blood Work
We recommend blood work prior to anesthesia in order to screen for major organ dysfunction, and screen for potential greater anesthetic risk. Cost: $133.50
Please pick one: (required)
I DO want pre-anesthetic blood work for my pet
I DECLINE pre-anesthetic blood work for my pet


IV Fluids
We recommend intravenous fluid support during surgery to help support kidney function and help maintain normal blood pressure. It also provides direct access to the vein in case of emergency, and is strongly recommended for patients over five. Cost: $104.80
Please pick one: (required)
I DO want an IV catheter and fluid support for my pet
I DECLINE an IV catheter and fluid support for my pet


Pain Control
Injectable pain control while hospitalized is included as a part of all our anesthesia and surgery costs, however, pain medication to go home with your pet is an additional cost that can vary due to you pet’s weight or the medicine the doctor chooses to send home.
Microchip Implantation
This is a permanent form of identification implanted under your pet’s skin. Feel free to ask for more information about how they work. (Registration of the microchip is included in price.) Cost: $45.00
Please pick one: (required)
I DO want a microchip implanted
I DO NOT want a microchip implanted


Toe Nail Trim
We would be happy to trim your pet’s nails while they are anesthetized. Cost: $0.00
Please pick one: (required)
I DO want a toenail trim for my pet
I DO NOT want a toenail trim for my pet


Please read:
Your signature on this form indicates that you are the owner of the above named animal and have consented to the procedure(s) listed above. I understand that during the performance of medical, surgical or anesthetic procedures, unforeseen conditions may be revealed that necessitate more extensive, costly or additional procedures than originally planned. If the staff at this veterinary hospital is not able to reach me, I consent to and authorize the performance of such procedures as are necessary in the judgment of the attending veterinarian.
By selecting below, this is your electronic signature for this online form: (required)
I agree
I do not agree



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