Owner Name *

First Name

Last Name

Phone Number *

Please list the best phone number to be reached at during the day.

(###)

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Do you prefer to receive a call or a text when contacted? *

Phone Call

Text Message

Either is Fine

Your pet will be undergoing a surgical procedure and general anesthesia today. To identify any underlying abnormalities your pet may have, we recommend pre-anesthetic bloodwork. This bloodwork will check the function of all major organs, evaluate signs of anemia/infection, and determine clotting ability. Knowing these values will help ensure your pet is as healthy and safe as possible for anesthesia. *

Yes, I have read the statement above and would like to proceed with pre-operative bloodwork today.

My pet has had a full comprehensive panel preformed prior to this surgical date (within the last 2 months)

No, I have read the statement above and decline pre-operative bloodwork today and understand the risk involved.

We highly recommend microchipping your pet if it does not already have one. This microchip will be placed underneath the skin in between the shoulder blades. Please note that this is not a tracking device but is strictly to help reunite you with your pet should it ever get lost. If you decide to microchip your pet during it’s procedure today, you will be given information to register with your information. *

Yes, I would like my pet to be microchipped today.

My pet is already microchipped.

No, I would not like my pet to be microchipped today.

We require the placement of an IV catheter to administer medications and fluids while under anesthesia. IV fluids will aid the body in stabilizing organs, stabilizing blood pressure and flushing the anesthesia out of the body more efficiently. Along with shaving the hair at the IV site, we will also shave other areas including the surgical site for surgical prepping and cleansing. I verify I am the owner/authorized agent of the pet named above and authorize the above procedure to be performed. I authorize the use of anesthesia and other medication as deemed necessary by the veterinarian of Goose Creek Pet Hospital. I understand that additional hospital personnel will be present and assisting in the procedure as directed by the veterinarian. I have been advised of the nature of this procedure to be performed and the risks involved. I also understand that there is always a risk associated with any anesthetic episode even in apparently healthy pets. I have had the opportunity to discuss my concerns with the veterinarian. 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 and all charges. Does your pet have a history of anesthetic reactions? *

No, my pet has not had any reactions to anesthesia in the past.

Yes, my pet has had a previous reaction to anesthesia.