Surgery and Anesthesia Consent Form

Name: Northwest Animal Hospital
Address: 2024 S River Rd, Des Plaines, IL, 60018, United States
Telephone: 847-296-3112
Price range: $

Thank you for choosing Northwest Animal Hospital! Please fill out the form as completely and accurately as possible.

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Surgery and Anesthesia Consent Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. If this is an emergency, or if your pet needs urgent care, please call us at 847-296-3112 for a faster response.

Owner's Name *

First

Last

Email *

Pet's Name *

Phone number you can be reached at? *

Another person who can make decisions concerning my pet is *

First

Last

Phone number they can be reached at? *

Procedure(s) to be performed *

Our on-site laboratory helps us screen for hidden problems before your pet’s procedure begins. These tests also provide a baseline for monitoring your pet during procedures, and can indicate chemical imbalances that could affect your pet under anesthesia. We require that all pets have a blood panel done within 60 days of the procedure. *

I have read and understand

I understand that during a dental cleaning my animal’s teeth and gums will be evaluated. Dental extractions may be indicated due to exposed gums, infection, cracks, fractures, etc. *

I have read and understand
My pet is not receiving a Dental Cleaning

IV Catheter Placement - All anesthetized patient will have an IV catheter placed. The most important reason to use an IV catheter during anesthesia is emergency preparation. Anesthetic emergencies are uncommon in veterinary practice, however when they occur there is no time to waste. Having a catheter in place means we can administer emergency, lifesaving drugs immediately, rather than trying to then place an IV catheter or give the needed drugs with a syringe and needle. *

I have read and understand.

I authorize anesthesia/surgery for my pet. The nature and risks of this procedure have been explained to me. I understand that some risks exist with anesthesia and/or surgery and I am encouraged to discuss any concerns associated with risks with my veterinarian before the procedure(s) are started. My signature on this consent form indicates that questions have been answered to my satisfaction. I authorize, Northwest Animal Hospital to perform any additional diagnostic, treatment or surgical procedure(s) deemed necessary for medical or surgical complications or any unforeseen circumstances. While Northwest Animal Hospital provides anesthesia monitoring and surgical services, I understand the risks and understand that the veterinarians and hospital team will do everything possible to reduce any risks. I will not hold Northwest Animal Hospital, the veterinarians or any team member liable for any complications that may arise. I assume full financial responsibility for this animal. *

I HAVE READ AND FULLY UNDERSTAND THIS SURGERY AND ANESTHESIA CONSENT FORM

Surgery and Anesthesia Consent Form

Surgery and Anesthesia Consent Form

Surgery and Anesthesia Consent Form

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