Peachtree Hills Animal Hospital Surgery Consent Form

Prefix*

Full Name*

First NameLast Name

Pet's name*

First NameLast Name

Phone Number*

Area CodePhone Number

E-mail*

How would you prefer to be contacted after surgery?*

PhoneText

Has the medical health of your pet changed since the surgical appointment was scheduled?

Your pet is scheduled for anesthesia and/or surgery. Our greatest concern is the well being of your pet. For this reason, prior to putting him/her under anesthesia, we will perform a complete physical examination. In addition to the physical exam, we believe every pet undergoing surgery should also have pre-anesthestic blood work, pain management, IV (intravenous) catheter and IV fluids. These procedures help reduce the risks of anesthesia and make your pet more comfortable.

Mircochip: While your pet is under anesthesia, we can place a permanent ID under your pet's skin. It is a microchip that contains a personal identification number. If your pet were to become lost and is brought to a shelter or animal care facility, they will check your pet for a microchip with a special scanner. When the ID number is picked up the scanner they will contact the microchip company's hotline and perform a quick search through their database. Once your pet is identified, you will be contacted and reunited with your pet. The procedure is an additional cost of $64.95.

Would you like a microchip for your pet*

Yes, Please microchip my petNo, I wish to decline a microchip for my petNo, My pet already has a microchip

Hip Radiographs: These are often useful in the early diagnosis of hip disease that can lead to arthritis or hip dysplasia, and must be taken while your pet is under anesthesia. This procedure is an additional cost of $235.27

Would you like radiographs of the hips while under anesthesia?*

Yes, I would like hip radiographs for my petNo, I would like to decline hip radiographs for my pet

Please look for a text message from us before the surgery. It will provide you information on the surgery and it will also be how we will communicate with you after surgery.

Is there anything else you would like us to know?

Peachtree Hills Animal Hospital Surgery Form