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Anderson, SC 29625

Anesthesia / Surgical Consent Form

Please complete the online consent form prior to your visit at Magnolia Veterinary Hospital. If you need immediate assistance, please call us directly at 864-222-2188.

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Magnolia Veterinary Hospital Consent Form

Compassionate, High Quality Care

Magnolia Veterinary Hospital Anesthesia / Surgical Consent Form

To ensure the best care possible, please fill out this form completely.

Client Information

Name *

First

Last

Primary Phone Number *

Secondary Phone Number

Email *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Pet Information

Pet's Name *

D.O.B/Age *

Pet Species *

Canine
Feline

Pet Gender *

Male
Male Neutered
Female
Female Spayed

Breed *

Color *

Weight *

Anesthetic and Surgery

Anesthetic and surgical procedure(s) to be performed: *

Canine / Feline OVH
Canine / Feline Castration
C-Section (NO OVH)
C-Section w/ OVH NO OVH
Dental Prophy w/ Extractions (if needed)
Laceration / Wound Repair or Treatment
Fracture Repair
Feline Declaw
Cystotomy / Urethrostomy
Growth / Mass Removal
Histopath
Sedation / Anesthesia
Microchip ($44.00) Although this can be done anytime, it is less traumatic while sedated
Other Procedure or Treatment not listed:

Pre and Perioperative:

We recommend preoperative labwork to screen liverand kidney function prior to anesthesia and/or surgery. This is required for animals over 7yrs of age receiving general anesthesia. These important tests can be performed prior to surgery for an additional cost of $59.50

Preoperative Labwork

Yes, I want my pet to have preoperative labwork
No, I do not want my pet to have preoperative labwork

IV catheter and IV fluids are required for all animals receiving general anesthesia. The cost for this is $53.00

I consent to CPR
I consent to DNR

CPR means "CardioPulmonary Resuscitation" and is the treatment (resuscitation) of a pet who has stopped breathing or whose heart has stopped beating.

DNR means "Do Not Resuscitate." This means that if a pet stops breathing or his/her heart stops, no attempts will be made to revive the pet.

I, the undersigned owner or agent of the pet identified above, authorize the staff of Magnolia Veterinary Hospital to perform the above procedure(s). I understand that some risks always exist with anesthesia and/ or surgery and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure(s) is/are initiated.

I agree

I understand that the attending veterinarian will make every effort to contact me regarding treatment in the case of unforeseen emergencies, or if additional treatment is required. If unable to contact me, I authorize the staff and attending veterinarian to proceed with any additional treatment as necessary.

I agree

I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved.

I agree

I also assume full responsibility for following aftercare / discharge instructions and for any additional expenses incurred after the surgical procedure is performed, such as follow up radiographs, re-check 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.

I agree

I have read and fully understand the terms and conditions set forth above.

Signature of Owner *

Clear Signature

Date *

FOR OVH(SPAY) SURGERIES, THERE MAY BE AN EXTRA CHARGE OF UP TO $45.00 IF YOUR PET IS DETERMINED TO BE PREGNANT OR IN HEAT DURING SURGERY. IF YOUR PET HAS FLEAS AND/OR TICKS, THEY WILL BE TREATED AT YOUR EXPENSE

Phone

Ready To Visit Us?

Use our online form to book an appointment with us! If you are experiencing an emergency, please call us. For emergencies outside normal business hours please go to the Animal Emergency Clinic in Greenville (864-232-1878).

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Emergency Hours

Monday – Sunday: 7:00 am – 12:00 am

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Appointment Hours:

Mon-Fri: 8:00 am – 6:00 pm
Sat: 8:00 am – 12:00 pm

Contact

Email: mvh@magnoliavet.com
Phone Number: 864-222-2188
Fax: 864-222-2190

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Hospital Info

Address: 2828 E. North Ave
Anderson, SC 29625

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Have a Question?

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