Anesthetic/General Surgical Consent Form Anesthetic and General Surgical Consent Form Name * Name First First Last Last Email * Patient's Name * Procedure to be performed * My cat has not eaten since * We use Sevoflurane anesthetic gas exclusively when anesthetic gas is necessary. Sevoflurane is a state-of-the art anesthetic gas that is used in 95% of human hospitals, including neo-natal infants. Sevoflurane allows the doctor to better control the depth of anesthesia. PRE-ANESTHETIC EXAM AND BLOOD TESTING: There is always a risk associated with anesthesia regardless of the procedure to be performed. Most, but not all of these risk factors can be determined by a complete physical examination and pre-anesthetic blood testing. We further reduce these risks by using only top quality anesthetic agents, continuous human and electronic monitoring and the use of IV fluids when appropriate. Grooming Sani Cut: $32 Brushout $23.00 Demat $22.00 Belly Shave $30.00 Resuscitation Orders Agreement Resuscitation Orders in the Event of an Emergency: For every cat in our care, we need to know, in advance, what your wishes are in the unforeseen event of an emergency if he or she stops breathing and/or their heart stops beating. CPR has the best chance of being successful if started immediately. We will make every attempt to contact you right away should your cat require resuscitative efforts. Please review and select one option below. Cardiopulmonary Resuscitation (CPR): All resuscitative efforts including placing a breathing tube, providing chest compressions and IV medications are to be attempted to restore normal heart function and breathing as deemed necessary by the doctor until I can be reached. Should my cat require cardiopulmonary resuscitation (CPR), I request that the doctor(s) pursue such medical care indicated above. I understand that this is a cost in ADDITION to any estimate and agree to pay this fee. The cost of full CPR is typically an additional $300 - $500 or more. Patients who are successfully resuscitated are often critical and will require transfer to a 24-hour facility for at least 24 to 48 hours of intensive care and monitoring following resuscitation. Do Not Attempt Resuscitation (DNR): Aside from reversing any reversible sedatives or anesthetic drugs that have been administered, no cardiopulmonary resuscitation (CPR) efforts are to be attempted allowing natural death. Be assured that we do everything possible to prevent this from happening and electing DNR does not affect selected treatments. Please select one of the following Cardiopulmonary Resuscitation (CPR) Do Not attempt Resuscitation (DNR) DENTISTRIES: Your doctor will make every attempt to reach you during the procedure should there be additional unexpected extractions above the current treatment plan. If we cannot reach you, please note if you: GIVE PERMISSION for additional extractions or DO NOT GIVE PERMISSION for additional extractions. Please select one of the following * I give permission for additional extractions I do not give permission for additional extractions AUTHORIZATION: By signing below, you are verifying that: I understand that there are risks associated with anesthesia and surgery, up to and including death. Results cannot be guaranteed. I am responsible for all fees incurred regardless of the outcome of the procedure Any fleas or parasites will be treated at my expense. I am the owner or agent for the owner of the above named cat, and I have the authority to execute this consent. I understand that estimates are not quotes and prices may vary based on the progress and condition of my cat. I hereby consent and authorize the above procedures Signature * signature keyboard Clear Today's Date * Phone # for today * Phone # 2 * May we text you? * Yes No Captcha Submit If you are human, leave this field blank.
