Surgical Consent Form

I, hereby Authorize the performance of the following procedure(s) and the use of such anesthetics as are required for those procedures(s):

Should, based on the medical judgment of a licensed Doctor of Veterinary Medicine, my pet named require cardiopulmonary resuscitation (CPR), including cardiac compression, defibrillation, positive pressure respiration, emergency drugs, or other heroic interventions, I request or decline that the doctor(s) at Altoona Veterinary Hospital pursue such medical care as indicated below. Altoona Veterinary Hospital has informed me that less than 5% of animals that require CPR will survive to be discharged from the hospital. I understand that despite the best efforts of the veterinarians and staff at the Altoona Veterinary Hospital, CPR may not save my pet’s life. I also understand that even if CPR is successful, my pet may never regain his/her normal mental and physical health and, thus, may leave him/her as an invalid.

RELEASE OF LEGAL LIABILITY: Regardless of whether I consent or decline to have CPR performed on my pet, in consideration for following my directive, I hereby waive, release and discharge any and all claims for damages, including, but not limited to claims for death, injury or property damage, whether or not resulting from the negligence, gross negligence, misconduct or other acts Altoona Veterinary Hospital, its veterinarians and staff, that I may have individually or on behalf of my pet, or that may subsequently accrue, as a result of honoring this directive, and I declare that any such veterinarian, staff and the Altoona Veterinary Hospital is acting in accordance with my directions. This is intended to be an advance release of legal liability, even if negligence or other misconduct occurs. Consent/Decline Directive for Cardiopulmonary Resuscitation and Release of Legal Liability.  

DIRECTIVE OPTIONS (Select A or B)

Pre-Anesthetic Bloodwork Release

Your pet is scheduled for an anesthetic procedure. In order to recognize any underlying abnormalities your pet may have, and to determine any increase in anesthetic risk, in accordance with our Pre-Anesthetic Bloodwork Protocol we recommend/ require a pre-anesthetic blood profile be completed.

• My pet has had Pre- Anesthetic Bloodwork completed. 
• For patients 5 years of age and older, pre-anesthetic bloodwork is MANDATORY.  
• For patients under 5 years of age, pre-anesthetic bloodwork may be optional unless there is a specific health issue concerning the doctor for the patient’s safety

Testing can significantly reduce the medical risks associated with anesthesia. A healthy appearing pet may be hiding symptoms of disease (a patient can lose up to 75% of kidney function before showing any visible signs of illness). Testing helps us evaluate your pet’s health for selection of an appropriate anesthetic protocol to minimize the risks related to anesthesia. If pre-anesthetic results are within normal ranges, we can proceed with confidence that anesthetic risk has been minimized. However, if pre-anesthetic results are not within the normal ranges, we may recommend additional diagnostics, alter the anesthetic protocol or reschedule the anesthetic procedure in an effort to safeguard your pet’s health and reduce the risk of potential complications. Additionally, these tests provide baseline levels for your pet and become part of his/her medical record for future reference.

I , owner or owner’s agent, of the pet identified above, certify that I am over 18 years of age and hereby authorize the doctor(s) at Altoona Veterinary Hospital to perform the above anesthetic and surgical procedure(s) for my pet.  I understand that some risk always exists 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.  While I accept that all procedures will be done to the best of the abilities of the staff at Altoona Veterinary Hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved.  I agree to pay a deposit of 50% of the estimated fees. The decision as to whether or not a deposit needs to be paid is at the discretion of Altoona Veterinary Hospitals Management. I also assume financial responsibility for the balance of the services on a cash, credit card, or check basis at the time my pet is discharged from the hospital. 

Owners will receive updated cost estimates whenever additional testing or precautions are necessary at the owner’s request.  Altoona Veterinary Hospital will also make every effort to contact owner prior to determining or performing any additional treatment that changes the original estimates, outside of emergency care which will be deemed necessary by the veterinarian.

I understand that Altoona Veterinary Hospital will make every reasonable effort to contact me prior to performing additional procedures and that if I cannot be reached an additional anesthetic procedure may be required in the future to avoid keeping my pet under anesthesia longer than necessary.