Owner Authorization & Release:
SURGERY CONSENT: I, the undersigned, do hereby certify that I am the owner (duly authorized agent for the owner) of the animal described above, that I do hereby give Robinson Drive Animal Hospital's attending veterinarian and staff (also hereby referred to as RDAH) full and complete authority to perform the surgical procedure described above. I understand that my pet is scheduled for a procedure that requires anesthesia. I realize that any anesthetic/surgical procedure involves some risks including but not limited to: anesthetic reaction, surgical site dehiscence and/or infection, and/or additional medications or treatments as a consequence of unforeseen complications. I understand that preanesthetic blood work does not guarantee the absence of complications. It may, however, reduce the risk of anesthesia or require changes in the anesthetic protocol by identifying certain conditions such as diabetes, liver, or kidney disease. I certify that I have notified the doctor of any pre-existing conditions, such as seizures, allergic reactions, previous anesthetic complications, etc. I do hereby forever release the said doctor, her agents, servants, or representatives from any and all liability arising from said surgery on said animal.
PRE-ANESTHETIC BLOOD TESTING CONSENT: We strongly recommend that a pre-anesthetic blood screen be performed prior to anesthesia. This may help us avoid possible complications from the procedure to be performed.
Pre-anesthetic bloodwork is REQUIRED for all animals 7 years of age and over.
Please indicate your choice below:
INTRAVENOUS FLUIDS AND PAIN MANAGEMENT: Optional intravenous fluids aid in the elimination of anesthesia byproducts, keep your pet hydrated, and assist in managing blood pressure. Pain medications are administered before surgery in most cases. In addition to standard pain management, administration of IV pain medication may be used depending on the procedure. (*Please note: As with pre-anesthetic bloodwork, IV fluid administration is also REQUIRED for all pets 7 years of age and over.)
ECG (CARDIO) SCREENING: Pre-anesthetic ECG can help pick up subclinical heart disease that can negatively impact anesthesia. While recommended for all pets, we are requiring ECG screening of all pets 7 years of age and over, and pet breeds of any age who are particularly at high-risk for heart disease (i.e., Cavalier King Charles Spaniels, Dobermans, Boxers, Maine Coon cats, etc.). If your pet does not fall in the above parameters and you would like to have the ECG, please indicate below.
Zorbium (Felines ONLY): Topical Buprenorphine pain medication. One in-clinic dose of Zorbium provides four days of continuous post-op pain control for at-home comfort. This will get rid of the need for you as the pet owner to administer pain medications at home.
PHOVIA THERAPY: Phovia is a fluorescent light therapy that stimulates healthy cell regeneration and has been shown to improve wound healing and decrease the risk of skin infections by almost 50%. Ask your technician for further details, and they will be happy to assist.
There are several factors that must be taken into consideration that will determine the amount of care needed for each dental procedure. Once your pet is placed under anesthesia, a more in-depth exam and dental x-rays will be performed, revealing the degree of dental disease evident and the possible need for extractions to keep your pet healthy and happy. The total cost of dental extractions can vary from $50 to $500 in addition to the dental itself. Therefore, a more accurate cost estimate will be created to be discussed with you.
A technician/doctor will contact you (while the pet is under anesthesia) to discuss any dental findings, needed extractions and cost. It is extremely important that we can reach you if contact is necessary as we call while your pet is under anesthesia. If any attempts to reach you are unsuccessful, 10-15 minutes will be given for you to return the call and discuss the findings.
If we are unable to reach you within the allotted timeframe, the technician will proceed with the dental scaling and polishing, and no extractions will be made.
Please initial your choice:
*By marking "no" I acknowledge that my pet will not receive the veterinarian's recommended extractions or treatment and will be awoken from anesthesia if I cannot be reached. I understand that only dental scaling and polishing will be performed, and that I will need to return with my pet at a later date to be anesthetized once again to perform any needed extractions.
HISTOPATHOLOGY: The tissue that was removed can be sent off to a laboratory and tested. This involves examination of the tissues and/or cells by a trained professional.
SEDATIVES AND/OR ELIZABETHAN COLLAR CHOICE: Patients who undergo soft tissue or dual procedures may be required to wear either an E-collar or a Recovery Suit to prevent licking or traumatizing the surgery site and hindering the healing process. Post-operative sedatives may also be prescribed if you feel your pet may need them to help with recovery. If applicable, please indicate the item preferred:
Fleas: If upon admission your patient presents with fleas or signs of fleas, a 24-hour flea prevention WILL be administered in clinic to prevent spread of infestation. This would be at the expense of the owner.
(Precautionary) CPR / DNR Authorization:
I understand the risks associated with any surgical procedure and the use of anesthesia. And though uncommon, there is the potential risk of cardiac arrest or other life-threatening consequences. Therefore, should such a situation arise, I authorize:
Cancellation Policy: Cancellation of your appointment within 24 hours of scheduled surgery will result in a $100 cancellation fee. The fee will be payable upon your next visit to Robinson Drive Animal Hospital. I have read the foregoing, understand what it says, and agree:
