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Surgical Consent Form


Surgical Consent Form

The quality of care expected in Veterinary Medicine is comparable to that in human medicine. We HIGHLY RECOMMEND that the following preventative and preemptive procedures be preformed to allow the safest anesthesia risk possible. These procedures also allow for a quicker and more comfortable recovery. It is especially important for older or patients with preexisting medical conditions. However, we recognize that extenuating circumstances sometimes will not allow for this level of care, therefore you may decline any of the following by selecting the appropriate choice.

Pre-Surgical Blood Screening

When your pet is admitted, rest assured that advances in anesthesia and surgery have made routine procedures relatively safe with a low rate of complications. However, since anesthesia or surgeries are not without risk, the American College of Veterinary Anesthesiology recommends that all animals have pre-surgical blood screening and EKG before anesthesia is administered. The pre-surgical blood screening includes a COMPLETE BLOOD COUNT (to evaluate for infection, anemia, or clotting deficiencies) and a CHEMISTRY CHECK (to evaluate liver and kidney enzymes - the filtering organs for anesthesia).

Pre-Surgical EKG

An EKG is an electrical tracing of the heart's function. It is the standard that cardiologist's use to evaluate the heart. It shows changes in the heart long before they can be heard with a stethoscope.

Vital Scan Monitoring

This is a multitude of sensors that are used to monitor your pet while it is anesthetized. It monitors heart rate, EKG, blood pressure, amount of oxygen in the blood, respirations, and temperature. These monitors allow us to make real time, split second decisions for your pet's well being.

IV Catheter with Fluids

An intravenous catheter is placed to allow quick access to a vein in case of emergency or to sustain critical care. Fluids are also given during procedures to maintain blood pressure, correct dehydration, replace blood loss, and speed recover.

Pain Medication

Animals cannot tell us when they are in pain, and often hide their pain as a defensive mechanism. If you do not want your pet to be in pain after surgery, we have very effective pain control medications that we highly recommend to keep your pet comfortable and speed up the recovery process.

COMPREHENSIVE CARE PACKAGE which includes all of the above pre-surgical and pain management options at a %15 savings.

Other Services

The following are optional services that are easily performed under sedation. Please check any services you DO WANT performed.

Consent and Anesthesia Authorization

I understand that during the performance of the procedure(s), unseen conditions may be revealed that necessitate the foregoing of the procedure(s) recommended. Therefore, I consent and authorize the performance of such procedure(s) as are necessary in the exercise of the veterinarian's professional judgement. I also authorize the use of appropriate anesthesia or medications and understand the hospital support staff will be employed as deemed necessary by the veterinarian. If work up is declined, I fully understand and accept the possible consequences of anesthesia and surgery and or dentistry being performed without the knowledge obtained from the previously mentioned work up. Clicking I Agree below will act as the signature of the owner/agent and acknowledge obligation for payment in full for services rendered.



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Perkins Road Pet Clinic
900 S. Perkins Road
Stillwater, OK 74074
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  • Phone: 405-624-3086
  • Fax: 405-624-3088
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