Surgery Consent Form

PLEASE READ AND INITIAL IN FRONT OF EACH APPLICABLE STATEMENT IN THE SPACE PROVIDED

I, the undersigned, owner or responsible party of the admitted patient, hereby authorize the veterinarians of the Edmonton West Animal Hospital & Spay/Neuter Centre (and whomever they may designate as assistants) to administer such treatments as necessary, and to perform surgical procedures and additional procedures as are therapeutically and/or diagnostically necessary as indicated by findings during medical evaluation. Since general anaesthesia or sedation is required in these surgical procedures, I understand and accept that there are always inherent surgical and/or anesthetic complication risks, including death of the patient.

The following options can help to reduce the risk associated with anaesthesia and maximize patient safety. We highly recommend these measures for every patient having a surgical procedure.

Pre-anaesthetic blood screen: the risk of anaesthesia complication is higher in animals with health problems. We recommend pre- anaesthetic blood screen for every patient having a surgical procedure. This checks for subclinical disease (hidden problems) not apparent on physical examination. On the basis of this blood work we can tailor your pet's anesthetic, pain management and recovery protocols to her/his individual needs. The fee for pre anaesthetic blood screen is $100.00.

**PLEASE READ THE FOLLOWING STATEMENT ONLY IF YOU DECLINED INTRAVENOUS FLUIDS:

Intravenous catheter: If you declined IV fluids, we STRONGLY recommend placement of an intravenous catheter. The intravenous catheter allows rapid administration of drugs should an emergency arise and can save vital time in the rare event of an anaesthetic complication.The fee for placing only an intravenous catheter without fluids is $30.00.

If you wish to take your pet to a board certified veterinary surgeon, there is only one clinic in Edmonton, Guardian Veterinary Centre, where they work on a referral basis. Select "I would like to be referred" below and inform a staff member if you wish to be referred.

I hereby certify that I have read and fully understand the above authorization for medical and/ or surgical treatment. I am aware that Edmonton West Animal Hospital does not employ any board certified surgeons, and authorize the general certified veterinarians of this facility to perform the above surgical procedure on my pet. I also certify that the procedure has been explained to my satisfaction, and that no guarantee or assurance has been made regarding the results that may be obtained. I acknowledge that any post surgical or post-anesthetic complications may require additional veterinary care or medications. Further, I assume full financial responsibility for all charges incurred to this patient.