Animal Medical Salado Surgical Consent Owner's NameLast Name(Required)First Name(Required)SpousePet's Name(Required)Emergency Phone Number(Required)Please read the following carefullyScheduled Date of Procedure(Required) MM slash DD slash YYYY select what is applicable(Required) Spay Neuter Dental Mass Removal Other Date of last heat/pregnancyCould your pet be pregnant? yes No Do we have authorization to extract teeth if recommended?(Required) yes No Mass histopathology(Required) yes No Number/Location of masses(Required)Other ( Details )(Required)Please initial your understanding of the following statements:Initial(Required)My pet has had nothing to eat or drink in the last 12 hours.Initial(Required)My pet has had no signs of illness in the last 48hours (Fever, cough, sneezing, vomiting, diarrhea, pain)Initial(Required)Your pet will have an intravenous catheter placed at the doctors discretion.Initial(Required)Pre-operative bloodwork is always recommended prior to anesthesia/sedation to prevent complications. This bloodwork is required if your pet is over 7 years or it is required by our surgeon. I have recieved an estimate for my pet's procedure.Initial(Required)Payment is due for all services the day of your pets surgical procedure.Initial(Required)The cost for follow-up appointments, imaging, bandaging, complications is not included with the payments made on the day of the procedure.Initial(Required)I understand that I am responsible for monitoring my pet when it goes home, making sure post-operative instructions are followed, and medications are received.Please Check Off any additional Services You Are Requesting: Nail Trim Microchip Express Anal Glands Sanitary Trim Ear cleaning Ear Hair Pluck Select AllPre-existing Conditions/Allergy A successful surgical procedure and outcome are dependent on clear communications about procedure benefits and potential outcomes. Every patient is treated for their individual needs with every effort made to minimize risk and complications but no guarantees can be made in regards to surgical outcome. I hereby certify that I am the rightful owner of this animal and that I have read and fully understand the authorization for medical and surgical treatments, the reason why surgery is necessary, its advantages, possible complications, and alternative modes of treatment. I understand how to perform post- operative care and that I can call the clinic if there are any issues. If I have an after hours emergency, I realize that AMS is not open after hours and am aware of where my nearest emergency animal hospital is located.NameDateDigital Signature(Required)Untitled
