"*" indicates required fields Pet InformationPatient Name* Procedure* Would you like your pet microchipped while sedated?* Yes No ConsentPre-anesthetic BloodworkIn order to recognize any underlying abnormalities your pet may have, we recommend having a pre-anesthetic profile run prior to sedation. This bloodwork checks the internal organs and blood count and is a vital part of safe anesthesia. Help us provide the best level of care for your pet by choosing to perform bloodwork prior to anesthesia or sedation. Please note, some procedures REQUIRE bloodwork. The staff at Birmingham Animal Hospital + Resort will review this with you when applicable.* I authorize bloodwork. I decline bloodwork and understand there are increased risk during anesthesia. I understand that unforeseen conditions may be revealed during the procedures that may require more extensive or different treatments. I understand that all reasonable efforts will be made to contact me to authorize any additional treatments. However, if these efforts are unsuccessful, I authorize the performance of any procedures or treatments that are deemed immediately necessary for the health and wellbeing of my pet.* InitialI understand that I assume financial responsibility for all services rendered.* InitialThe veterinarian and/or staff of Birmingham Animal Hospital + Resort has described the procedures to be performed and has explained to my satisfaction the purpose for performing them and the risks involved with them. I realize that there can be no guarantee as to the outcome of any procedures.* InitialI hereby authorize anesthesia and/or surgery for my pet. I understand that some risks always exist. My signature on this consent form indicates that any questions have been answered to my satisfaction. While Birmingham Animal Hospital + Resort provides the highest quality of anesthesia monitoring and surgical services, I understand that there are rare complications associated with any anesthetic or surgical procedure. I have been advised that there is an extremely small risk of death, complications, or side effects (which can present themselves well after the procedure) every time an anesthetic is used and that I have been made aware of this possibility. I acknowledge the risks and understand that the veterinarians and hospital staff will try to minimize such risks. I will not hold Birmingham Animal Hospital + Resort, the veterinarians, or any staff member liable for any complications that may arise* InitialAuthorizationIn the case your pet were to suffer cardiac and/or pulmonary arrest, do you authorize us to provide life-saving measures (CPR)? If you choose to allow these procedures for your pet, you will be contacted as soon as possible to be informed of the situation and given the options of how to proceed.* CPR – I authorize appropriate life saving measures. I understand and assume all financial responsibility for this. DNR – I do not wish for life saving measures to be employed. I am electing “DO NOT RESUSCITATE” status for my pet. Owner Signature Reset signature Signature locked. Reset to sign again Date MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged.
