Surgery and Anesthesia Consent Form

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Owner's Name

As owner/agent of the pet described above, I hereby give my consent to the Keota Veterinary Clinic to perform the following under general anesthesia:

General Information Regarding Anesthesia:

General Anesthesia – We usually use a combination of injectable anesthesia and inhalant anesthesia. Injectable anesthesia is primarily metabolized by the liver and/or kidneys. Inhalant anesthesia is isoflurane gas, which is often used in human medicine. Isoflurane is primarily eliminated through the respiratory tract rather than through the kidneys or liver.

Monitoring – Your pet is closely monitored throughout the entire procedure/anesthesia. Your pet’s heart rate, respirations, blood pressure, CO2, and oxygen levels are continuously checked by our staff and anesthetic monitoring equipment.

IV Catheter and Fluids – An intravenous catheter is placed to give access for medication and fluids. This keeps your pet hydrated and will help your pet recover quicker. Cat neuters are given subcutaneous fluids under the skin.

Above the cost of the basic surgical procedure

Vaccinations – Immunizing you pet is an important procedure that in most cases will provide protection against an illness that may be life threatening. A series of shots will be given at the beginning of a pet’s life or for pets that are un vaccinated and other shots will be given yearly or every three years based on the risks of contracting the disease.

Is your pet current on vaccinations?

Microchip – A microchip is approximately the size of a grain of rice and is placed under your pet’s skin using a needle. The microchip itself carries a number which is put into a database with contact information like name, phone number and address. If your pet wanders off and a pet shelter or vet’s office picks him or her up, they can scan your pet’s body to find out who they belong to. Remember that microchipping is useless unless you keep your records up to date. (Microchipping $32.50 – Registration $20)


Pre-anesthetic Blood Safety Screen – Our on-site laboratory lets us screen for hidden problems before your pet’s treatment begins. These tests also provide a baseline for monitoring your pet during surgery and can indicate chemical imbalances that could affect your pet under anesthesia. *We recommend this bloodwork for ALL our patients undergoing anesthesia. ($80)

Pre-anesthetic Blood Safety Screen
Heartworm/Lyme/Ehrlichia/Anaplasma Test for dogs ($35)
Heartworm/FeLV/FIV Test for cats ($35)

Post-operation canned food – Studies have shown the sooner we can have pets return to eating the better they feel and the better they recover. The food is also specially formulated to aid in healing. The regimen runs for the first 5 to 6 days after surgery. ($15-35)

Post-operation canned food

Authorization and Risk Assessment:

I understand that during these procedures great care is taken to ensure my pet’s health, but unforeseen conditions may be revealed that necessitate an extension or variance in the procedure(s) defined above. I authorize Keota Veterinary Clinic to perform any additional diagnostic, treatment or surgical procedure(s) deemed necessary for medical or surgical complications or any unforeseen circumstances. I understand the risks and understand that the veterinarians and hospital team will do everything possible to reduce any risks. I will not hold Keota Veterinary Clinic, the veterinarians or any team member liable for any complications that may arise.

By signing this document, I certify that I have read this document, understand it, and have had all of my questions answered to my satisfaction and I agree to the conditions of treatment. My signature below authorizes the veterinarians at the Keota Veterinary Clinic to perform said procedure(s)/treatment(s) described above.

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