SURGICAL/ANESTHETIC AND MEDICAL CONSENT FORM
Canine Spay 2 Years and Older
The following procedures will be performed today:
Pre-Anesthetic Testing Because of our commitment to providing you with the highest quality of veterinary care, we require pre-anesthesia testing. Each surgical or anesthetic procedure has some risk involved. Advances in anesthesia have made routine procedures relatively safe, but occasional problems can occur due to pre-existing conditions not evident on physical examination. If there is any indication of an abnormality, we will either contact you before proceeding or take steps necessary to ensure the safe care of your pet.
HEALTH SCREEN II
We need a urine sample. Please collect at home or avoid letting your pet urinate on the way in to the hospital.
PCV (detects anemia)
Platelet estimate (clotting ability)
Total Protein (assesses hydration and protein level)
BUN and Creatinine (kidney)
Urinalysis (kidneys and diabetes)
ALP (liver and adrenal glands)
Glucose (low or high blood sugar)
Sodium, Potassium, Chloride (electrolytes can be abnormal with many diseases)
IV Catheterization - for fluid therapy, IV medication or any emergency drugs if necessary
Fluid Therapy — intravenous fluids to maintain normal blood pressure, preserve hydration and ensure adequate blood flow to vital organs
Anesthesia/Monitoring — respiration, blood oxygen level, heart and blood pressure
Anesthesia — pre medication, IV and gas anesthesia
Surgical Procedure - castration
Recovery Monitoring — including pain assessment
Pain Medication Dispensed — when necessary
Total Cost: $768 (Less than 50 lb.) / $864 (50 lb and above)
Please indicate if you would like any of the following additional procedures done.