Surgery and Anesthesia Consent Form

Client’s Name: Pet’s Name:

Anesthetic procedure(s) to be performed:

General Information:

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 the pet under anesthesia.

Anesthesia - East Lake uses the same safe Isoflurane gas that is often used in human medicine. Isoflurane is primarily eliminated through the respiratory tract rather than through the kidneys or liver. This reduces the risk associated with anesthesia and allows for a quick recovery.

Monitoring - Your pet’s blood pressure, temperature, heart rate and rhythm, respirations, and oxygen levels are closely monitored using state-of-the-art equipment. We use a range of techniques and equipment to help maintain your pet’s body temperature while under anesthesia.

Intravenous catheter with fluids - Administration of intravenous fluids helps the patient recover more quickly from anesthesia, maintains blood pressure, and increases circulation during anesthesia. The intravenous catheter is also used to administer medications if needed.

Pain management - Your pet’s comfort is important to us. We proactively control pain associated with any procedure with appropriate pain management medications.

Recommended Services:

Pre-anesthetic blood safety screen ($91.77) Yes: No:
Dental Procedure:
OraVet Barrier Sealant in-clinic application ($36.00) Yes: No:
Extractions ($30-$200 each) Yes: No:
Microchip placement for identification purposes ($48.50) Yes: No:
Juvenile Prophy if additional procedure and under 1 year of age ($65.00) Yes: No:

Authorization and Risk Assessment

I authorize anesthesia/surgery for my pet. The nature and risks of this procedure have been explained to me. I understand that some risks exist with anesthesia and/or surgery and I am encouraged to discuss any concerns associated with risks with my veterinarian before the procedure(s) are started. My signature on this consent form indicates that questions have been answered to my satisfaction.

I authorize East Lake Veterinary Hospital to perform any additional diagnostic, treatment or surgical procedure(s) deemed necessary for medical or surgical complications or any unforeseen circumstances. While East Lake Veterinary 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 reduce any risks. I will not hold East Lake Veterinary Hospital, the veterinarians or any team member liable for any complications that may arise.


Name of Pet Guardian: Date:

Phone number where I can be reached: