Name *

First

Last

Pet's Name *

Primary Phone *

Secondary Phone

Email *

Our greatest concern is the welfare of your pet. Before today’s procedure we will perform a physical examination and notify you of any abnormal findings that could affect anesthetic risk. During the procedure we will continually monitor your pet’s vital signs and will have an intravenous catheter in place to allow administration of fluids and any necessary medications. These precautions will help to minimize risk, but even healthy patients with close monitoring have a small chance of complications, up to and including death. To further decrease any risks and ensure your pet’s health and safety, we strongly recommend blood testing to identify unseen disorders of the liver, kidneys, and/or immune system.

These pre-anesthetic blood tests are strongly recommended for all pet’s, especially for those over 7 years of age or with pre-existing medical conditions. Please select one: *

NO, my pet has already had bloodwork
YES, I want my pet to have the recommended blood work (additional cost).
NO, I decline the recommended screening and understand the above-stated risks

What medication(s) is your pet currently taking and when was it last given? *

Your pet will receive pain medications before and after surgery, which is included in the cost of the procedure. Any additional procedures, injections (anti-inflammatories, nerve blocks, etc.), and/or prescribed oral medications to be administered at home will incur additional fees. Please check any additional procedures that you would like us to perform on your pet today (to be completed at the veterinarians discretion):

Removal of deciduous (baby) teeth, if any are present
Vaccinations (price varies with each vaccine)
Nail trim (if needed at no charge
K9 Ear cleaning
Anal gland expression
Microchip placement (includes registration)
For Spay and Neuter procedures, add a small "altered" tattoo color line at the incision site. This signifies that the pet has been surgically altered.
Other

Please Specify Other *

Checkboxes *

I have received a written estimate for today’s procedure and am aware I will be notified by the veterinarian before any changes are made

If your pet is having dental work, select one of the following: *

I authorize any necessary extraction(s), please call first at the numbers listed above. I understand that you will make every attempt to reach me. However, in the event I am unreachable you will proceed with all necessary extractions, and I will be responsible for the costs incurred.
I do not authorize extractions. Please call first at the numbers listed above to discuss recommendations. I understand that you will make every attempt to reach me. However, in the event that I am unreachable, we may have to re-anesthetize my pet at a later date to complete the procedure.

Please initial:

My pet has not eaten in the last 8 hours and is acting normal at home.

In the event of an emergency, Bay Animal Hospital veterinarians will perform CPR/life-saving measures while we attempt to reach you.

Please select your authorization below: *

Perform CPR
Do Not Perform CPR

I have read and understand this consent form and give Bay Animal Hospital permission to anesthetize my pet. I understand that payment is required in full at the time of pickup and I may be asked to leave a deposit at drop-off. *

I have read and understand this consent form and give Bay Animal Hospital permission to anesthetize my pet. I understand that payment is required in full at the time of pickup and I may be asked to leave a deposit at drop-off.

Signature *

Clear Signature

Date *

Surgical/Anesthesia Consent Form

MAKE AN APPOINTMENT

PHARMACY

FIND US

PET RECORDS

ONLINE STORE

About Bay Animal Hospital

Business Hours

Sign up for our newsletter!

We proudly serve the pets of Manhattan Beach, CA, and beyond.