Pet's Name:*

*	As Owner/Authorized Agent of the above named animal, I hereby authorize Petsadena Animal Hospital to perform the following under general anesthesia:

Procedure(s):

In case of an emergency and/or prior to additional procedures, you will be contacted by telephone.

The phone number(s) where you can be reached TODAY is:

Phone Number 01:

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Phone Number 02:

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Surgical/Anesthesia Information:

-	All pets undergoing anesthesia at Petsadena Animal Hospital are required to have pre-anesthetic blood testing to look at basic organ function and to tailor anesthetic medications used. This will also check for pre-existing medical conditions, which may increase the risk of complications during surgery
-	An intravenous catheter will be placed to provide immediate access to your pet’s circulatory system, this allows for rapid administration of drugs should an emergency situation arise. Your pet will also be administered intravenous fluids to help maintain normal blood pressure, protect vital organs, and maintain proper hydration.
-	All pets undergoing surgery will receive pain injections while in the clinic. Post-operative pain management is a concern with virtually all surgical procedures. Most procedures merit at-home oral medication for several days after surgery and will be dispensed at the veterinarian's discretion.

Additional elective procedures offered (please check services that you would like performed):

	Nail Trim ($8.40)
	Ear Cleaning ($28.34-49.75)
	Microchip Implantation ($50.60)
	Anal Gland Expression ($22.89)
	Laser Therapy for post-surgical pain and swelling ($15)

Authorization and Risk Assessment:

*	The nature of the procedure and the potential risks, have been explained to me and I understand the procedure(s) to be performed. I understand that some risks always exist with anesthesia and/or surgery, and I am encouraged to discuss any concerns I have about those risks with my veterinarian before the procedure(s) are initiated. My signature on this consent form indicates that any and all my questions have been answered to my satisfaction.
*	I understand that during these procedures great care is taken to ensure my pet’s health, but unforeseeable conditions may occur that necessitate an extension or variance in the procedure(s) defined above. I authorize Petsadena Animal Hospital to perform any additional diagnostic, treatment or surgical procedure(s) deemed necessary for medical or surgical complications or any unforeseeable circumstances. I accept responsibility for any result in additional charges
*	While Petsadena Animal Hospital provides the highest quality of anesthesia monitoring and surgical services, I understand the risks and understand that the veterinarians and hospital team will do everything possible to minimize any risks. I will not hold Petsadena Animal Hospital, the veterinarians or any team member liable for any complications that may arise. No warranty or guarantee has been stated or implied to me as to the results or cure afforded by these treatments or procedures.
*	I understand that I am assuming full financial responsibility for all services rendered at the time my pet is discharged from the hospital.