Neuter Consent Form Are you a new client?(Required) Yes No Please complete our New Client Form before your visit.Owner's Name(Required) First Last Surgical Procedure to be performed: Orchiectomy (Neuter)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 InformationPet's Name(Required)Is this a new pet?(Required) Yes No Did your pet eat this morning?(Required) Yes No Is your pet current on their vaccines?(Required) Yes No My pet(s) need vaccines and I will cover the cost for the vaccines Has your pet ever had any vaccine reactions?(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 monitoring Blue Diamond Animal Hospital staff Veterinary Graduates Awaiting Licensure (VGAL). While they possess the necessary skills and knowledge, it is essential to acknowledge that their licensure is pending. The well being of the animal remains the primary concern. I'm aware of this arrangement and provide consent to proceed.(Required) I have read and understand Recommended/Optional Services (Additional Cost):Please select Accept or Decline Below:Pre-Anesthetic Bloodwork: 1. Adult Panel: Recommended for all pets and required for pets 7 years and older 2. Pre-op profile: Min. Recommended for pets 6 years and younger. Looks at liver and kidney values only (includes CBC).**If your pet is 7 years if age or older, please select Adult $175** Adult $175 Pre-op $125 Decline Pre-Operative ECG: Recommended for all pets 7 years or older (Required for those pets with a heart murmur prior to any anesthetic procedure). An ECG evaluates the hearts rhythm, and may aid in the diagnosis of a potential issue with the heart. Accept $86 Decline Additional Pain Medication: Recommended to aid in pain relief and healing. An opioid injection will be administered after the surgical procedure is done, and an additional oral pain medication will be sent home with you ($60) If your Pet weighs more than 70lbs - ($90) Accept $60 - $90 Decline Post-Op Sedatives: It is important for your pet to relax during the recovery period after surgery. We recommend sedatives for high energy pets since they do not understand the nature of their procedure. Prices vary by weight of pet. Accept $10 - $60 Decline Cerenia Injection: Cerenia helps to control vomiting during and after surgery. Animals given cerenia prior to surgery are far less likely to vomit during and after the procedure and eats more readily when they get home. Accept $64 Decline Laser Therapy: Laser Therapy promotes faster healing of any incision site. We highly recommend post surgery laser therapy as it helps reduce healing time as well as time spent in an E-collar. If Cancer is suspected laser therapy is not advisable. Accept $24 Decline Deep Ear Cleaning: It can be hard to clear debris in our pets ears when they are awake. We offer this service to do an in depth cleaning while they are anesthetized. Accept $48 Decline Other Services Nail Dremel: Accept $33 Decline Nail Trim: Accept $16 Decline Anal Gland Expression: Accept $20 Decline Vaccines: Accept Decline Microchip Implantation (Includes registration): Accept $50 Decline Your pet will be undergoing general anesthesia plus a surgical procedure today. In order to recognize any underlying abnormalities your pet may have, we highly recommend having a pre-surgical blood profile run on your animal. This consists of a CBC, which will check blood cells and chemistry which will also check blood glucose, kidney, and liver enzymes. These blood tests will help us to assess the health status of your pet more completely and determine if there are any additional precautions we need to take before surgery. We require a blood profile for animals older than seven years.(Required) I have read and understand Any pets with a heart murmur or other heart related health concern are required to have a pre-operative ECG at Blue Diamond Animal Hospital prior to surgery. This is to ensure that your pet is stable enough to go under anesthesia or if we need to make any adjustments to our pre-surgical medications/induction agents for your pet. Some circumstances require pets with severe heart conditions to see the cardiologist at the Las Vegas Veterinary Specialty Center (LVVSC) to be cleared for anesthesia.(Required) I have read and understand 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)(Required) I authorize CPR I do not authorize CPR As 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, 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.(Required) I have read and understand this authorization and consent. I further understand that I assume financial responsibility for all services rendered. Digital Signature(Required)Date(Required) MM slash DD slash YYYY CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
