Your Full Name
Hospitalization, Anesthesia and/or Surgical Procedure(s) and/or Dentistry Procedure(s) to be performed:
Please review the following carefully
I, the undersigned, am the owner or agent of the pet identified above. I authorize General Booth Veterinary Hospital to perform the above procedure(s).
I understand that there are certain risks with hospitalization, anesthesia and/or surgical procedure(s), and/or dentistry that could involve bodily injury or death and that the risks are present in any procedure that requires any form of anesthesia. General Booth Veterinary Hospital takes every precaution to ensure the health and safety of your pet. To increase the safety of any procedure involving anesthesia, we require pre-anesthetic bloodwork and a presurgical EKG to determine your pet's physical condition before going under anesthesia.
I acknowledge that any changes in my pet's condition or discovery of other findings during the treatment may necessitate a change in or an extension of the original treatment plan. If I cannot be reached, General Booth Veterinary Hospital has permission to proceed with medical care that will preserve my pet's health or minimize the need for and risk of additional and costly services later.
While I accept that all procedures will be performed to the best of the abilities of the staff at the hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved.
I also assume full responsibility for any additional expenses incurred after the surgical procedure is performed, such as follow-up radiographs, re-check physical exams, and additional surgery due to post-op complications. These are more likely to occur when there is a failure to comply with the aftercare instructions.
If your pet is being admitted for a dental procedure, it will include a routine cleaning (ultrasonic scaling, polishing, fluoride treatment), a complete oral exam with probing/charting of all teeth, and any abnormalities along with full mouth dental radiographs. If abnormalitied=s are identified, the doctor or nurse will call to discuss the additional recommended treatments not discussed at hospital admittance.
What number would be best to reach you at during the procedure?
Please review and select one of the options below
*** If you cannot be reached during the procedure at the provided contact number after two (2) attempts, please choose ONE of the following as authorization for extractions and additional treatments.
*I understand if I cannot be reached at the provided number, then my pet will be recovered from anesthesia and the additional treatment options will be discussed and performed on another day.
I understand if I cannot be reached at the provided number, then my pet will be recovered from anesthesia and the additional treatment options will be discussed and performed on another day. Please review the following carefully
In the event of an unforeseen emergency, I understand that the attending veterinarian will make every effort to contact me without delay regarding treatment. Please know that we will take every precaution to ensure that your pet is safe and also healthy enough to undergo their procedure today. However, very rarely, emergencies happen and we want to know your preferences in no one can be reached.