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We recommend performing pre-anesthetic blood work with any procedure or treatment that may contain sedation or anesthesia. This is to assist in detecting any potential vital organ abnormalities prior to any treatment. This will be an additional charge of $118.00. *

I approve
I decline

Treatment(s) to be performed: Anesthesia, spay/neuter, medications, ear tip (if community cat), abdominal tattoo, rabies (if needed), hospitalization.

Additional Options

E-Collar ($15.38)
Pain Meds ($15.00)
Microchip ($25.00)
Convenia Injection (cats only) ($40.00)

Capstar Acknowledgement:  I understand that if any fleas are seen on my pet that a Capstar (a pill that kills fleas for up to 24 hours) will be administered at an additional charge of $7.74. This is to protect the hospital and any other patients from any possible flea infestation or flea bites. Your agreement is an indication you accept this policy. *

I have read and understand

I verify I am the owner (or authorized agent for the owner) of the above-named pet and authorize the above procedure(s) to be performed. *

I have read and understand

I authorize the use of anesthesia and other medication as deemed necessary by the veterinarian and understand that hospital personnel will be employed in the procedure(s) as directed by the veterinarian. I have been advised as to the nature of this procedure to be performed and the risks involved. I understand that there is always a risk associated with any anesthesia episode, and have been informed that this is a low-cost spay/neuter procedure and I understand an intravenous catheter and endotracheal tube is not placed in my pet during this procedure. Should my pet exhibit respiratory arrest and/or cardiac arrest, I elect: *

CPR to be performed on my pet and understand that I will be responsible for all costs incurred, which could range from $50 to $150 for initial stabilization. I accept that if the hospital staff is unable to reach me within 20 minutes after the initial CPR procedures, and after exercising reasonable medical judgment, determine that there is no hope for success, the staff will cease further CPR procedures.
DNR - I DO NOT wish the staff to perform CPR on my pet. I understand that if my pet suffers from cardiac arrest, respiratory arrest, collapse or unconsciousness if CPR is not performed, my pet will pass away.

I understand that the veterinarian does not perform an examination of my pet when a voucher is being used. *

I have read and understand

I understand that should any post-op complications arise my pet will need to have an examination prior to any treatment or medications. *

I have read and understand

I understand a rabies vaccination will be administered to my pet unless prior proof of vaccine is provided. *

I have read and understand

I understand that my pet will receive an ink tattoo, with the exception of male cats, and all cats labeled as "community" will receive an ear-tip. *

I have read and understand

I understand that should my pet be pregnant, the pregnancy will be terminated and there may be an additional charge. *

I have read and understand

Date *

Anesthesia/Surgery Consent Form

Please complete this form before your visit.

We care for pets in Cut Off, Louisiana and beyond!

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