Spay Consent Form

Questions

Name*

First Last

Pet's Name*

Phone Number*

Additional Services

Current Meds and Date/Times Last Received:*

Has your pet had food this morning?*

Yes
No

Would you like us to microchip your pet?*

Yes
No
N/A

Has your pet had a reaction to anesthesia in the past that you are aware of?*

Yes
No
N/A

Procedure

Mainstay Veterinary Practice uses state-of-the-art surgical monitoring equipment to monitor your pet’s blood pressure, temperature, heart rate and rhythm during surgery. We provide pain medication for pets before, during, and after surgical procedures. An IV catheter will be placed to administer fluids. Along with shaving the hair at the IV catheter site, we may also shave other areas including the surgical site and monitor sites. Pre-Anesthetic blood work is required for all procedures requiring general anesthesia. Pets will be treated for fleas, ticks or ear mites, if found, as an additional expense. Animals unvaccinated or overdue for Rabies immunization will be vaccinated as an additional expense.

Today we will perform a surgery to remove your pet’s ovaries and uterus. We will shave the abdomen and place sutures to close the incision. These will be buried under the skin and will dissolve on their own.

Emergencies:

I elect for cardiopulmonary resuscitation (CPR)
I elect for a DNR (do not resuscitate) status for my pet.

I, being the responsible party for the above animal, authorize the performance of the procedure(s) outlined above by the professionals and staff at Mainstay Veterinary Practice. I understand that anesthesia always involves some amount of risk and that during the performance of this/these procedure(s), unforeseen conditions may be revealed that necessitate an extension or variance in the procedure(s) set forth above. I expect Mainstay Veterinary Practice to use reasonable care and judgment in performing the procedure(s) to the best of their abilities. I realize that no guarantee or warrantee can ethically or professionally be made regarding the results or cure. I am also aware that unforeseen complications resulting from the procedure(s) will not relieve me from any obligations to all reasonable costs incurred regarding the animal. I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time of my pet’s release and that a deposit may be required for surgical treatment.

I, being the responsible party for the above animal, authorize the performance of the procedure(s) outlined above by the professionals and staff at Mainstay Veterinary Practice. I understand that anesthesia always involves some amount of risk and that during the performance of this/these procedure(s), unforeseen conditions may be revealed that necessitate an extension or variance in the procedure(s) set forth above. I expect Mainstay Veterinary Practice to use reasonable care and judgment in performing the procedure(s) to the best of their abilities. I realize that no guarantee or warrantee can ethically or professionally be made regarding the results or cure. I am also aware that unforeseen complications resulting from the procedure(s) will not relieve me from any obligations to all reasonable costs incurred regarding the animal. I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time of my pet’s release and that a deposit may be required for surgical treatment.*