Ear Crop Consent Form Are you a new client?(Required) Yes No Please complete our New Client Form New Client Form before your visit.Owner's Name(Required) First Last Surgical Procedure to be performed: Ear Crop Best phone number to contact after procedure(Required)Email(Required) Today's Date(Required) MM slash DD slash YYYY Date of Procedure(Required) MM slash DD slash YYYY Pet's Name(Required) Pet's Gender(Required) Female Male Is this a new pet?(Required) Yes No Did your pet eat this morning?(Required) Yes No Has your pet ever had a seizure?(Required) Yes No Has your pet been ill or not feeling well within the last two weeks?(Required) Yes No Is your pet on any medications?(Required) Yes No Like you, our greatest concern is the well-being of your pet. Prior to administering anesthesia to your pet, a full physical exam is performed. Included in the price of each surgery/procedure is: -An intravenous catheter and fluid therapy -Pain medication before the procedure and medication to go home -Anesthesia monitoringAs the owner or agent of the above animal, 18 years of age or older, I hereby give my consent to Blue Diamond Animal Hospital to perform a surgical procedure on my pet.(Required) I consent I understand that ear crops are performed at the veterinarians discretion as it is a cosmetic procedure.(Required) I consent I have been informed that there are certain risks and complications associated with any operation or procedure of this nature. Risks of general anesthesia include death, but I understand that all necessary measures will be performed to reduce risks and complications. I understand that an ear crop procedure is generally considered safe.(Required) I consent I understand there is no guarantee that an ear crop will stand. The ear crop is done and designed to make the ears stand but the outcome and whether or not the ears will stand is determined as much by the aftercare.(Required) I consent I understand there is no guarantee that an ear crop will stand. The ear crop is done and designed to make the ears stand but the outcome and whether or not the ears will stand is determined as much by the aftercare.(Required) I consent I understand that all pets presented to Blue Diamond Animal Hospital for a procedure must be current on vaccinations.(Required) I consent I understand that my pet will need to stay overnight after an ear crop for observation.(Required) I consent *Doberman Pinschers will require a BMBT (buccal mucosal bleeding time) test before ear crop can be performed. If this test is abnormal, further testing is required to rule-out von Wilebrand's disease. This is a blood clotting disorder that can be inherited in purebred dogs, most commonly Doberman Pinschers. Pets that have von Wilebrands disease are not eligible for ear crop procedure.(Required) I have read and understand CPR - Your pet may require cardiopulmonary resuscitation (CPR), including cardiac compressions, positive pressure respiration, emergency medications, or other interventions. If I request such emergency procedures, I agree to be held responsible for veterinary services provided to my pet while staff members pursue treatment and try to reach me for further directions. Regardless of my pet’s recovery or survival, I agree to pay CPR fees in addition to other fees already identified by the practice and agreed upon by me. By declining CPR, in the unlikely event my pet becomes unresponsive during anesthesia, I consent to allow my pet to pass away without intervention(Required) I authorize CPR I do not authorize CPR Consent(Required) I have read and understand this authorization and consent. I further understand that I assume financial responsibility for all services rendered.I, the undersigned, do hereby certify that I am the owner or duly authorized agent for the owner of the animal described above and have the authority to execute this consent. I understand that during the performance of the procedure, an unforeseen situation may arise that necessitates an extension or variance in the procedure set above. I hereby authorize Blue Diamond Animal Hospital to use reasonable care and judgment in performing the procedure. I have been advised as to the nature of the procedures and the risks involved in performing general anesthesia on the above-described animal. I realize that results cannot be guaranteed. I understand that all pets presented to Blue Diamond Animal Hospital for a procedure must be current on vaccinations.Digital Signature(Required) Date(Required) MM slash DD slash YYYY