Pet Information

Pet's Name *

Contact Information

Owner's Name *

First

Last

Email *

Phone *

I consent to receive SMS text messages from Alamo Area Veterinary Clinic. Msg & data rates may apply. Reply STOP to opt-out. *

Yes
No

Additional Phone

Secondary Contact: *

First

Last

* This person has your authority to consent to medical decisions regarding your pet's surgical care in the event we cannot reach you.

Secondary Contact Phone *

Today's procedure is: (example: spay, neuter etc.) *

Additional Services Desired While Patient Is Sedated

• We offer Pre-Anesthetic Blood Work to check for medical problems that may not be detected on physical exam. This blood work checks the following: CBC, liver & kidney enzymes, glucose & electrolytes. The pre-anesthetic testing DOES NOT GUARANTEE that there will not be any complications but it does help to greatly reduce the risk as well as identifying some conditions that may need to be treated. We do recommend this testing for all of our surgery patients. The fee is an additional $128.00
• We also offer Pre-Anesthetic ECG to check for heart problems. These will be evaluated by a cardiologist by “telemedicine” and is strongly recommended for any pets that have existing heart problems or have had issues with anesthesia in the past. The fee is an additional $100.00
• We also offer PETLINK™ Microchip which provides a permanent form of identification. You will register with a national registry and they will contact you if your pet is ever found and scanned by a shelter or veterinary hospital. The fee is an additional $76.25

Please select any/all that you would like us to provide while your pet is sedated

Implant Microchip
Pre-Anesthetic ECG
Other (specify below)

Please specify the additional service(s) you'd like provided to your pet *

Would you like a pre-anesthetic blood work? *This may be included in an estimate you received. *

Yes
No

Authorization

I, the owner or authorized agent for the owner of this animal, give my permission for anesthesia and the following procedure(s) to be performed. I understand that during the procedure(s) unforeseen conditions may be revealed that necessitate extension or a change in procedure(s). Thereby I authorize and give my consent for the performance of any procedure(s) that is/are deemed necessary by the attending veterinarian(s). I understand the risk associated with anesthesia and procedure(s) and give Alamo Area Veterinary Clinic permission to perform any emergency procedure(s)as deemed necessary. I am aware that I am financially responsible for the resulting fees for the additional procedure(s). *

I have read, understand, and authorize

Payment due upon services rendered. *

I have read, understand, and agree.

There is a $100.00 fee if you do not show up for your surgery or cancel within 48 hours of the surgery date *

I have read, understand, and agree.

I HAVE READ AND FULLY UNDERSTAND THIS ANESTHESIA CONSENT FORM *

Yes

Signature of Responsible Party *

Date *

alamo area veterinary clinic

Anesthesia Consent Form