I am the owner or the authorized agent for the owner of the animal described above, and I have the authority to execute this consent. My signature below certifies that I am over eighteen years of age. I have been informed that there are certain risks and complications associated with sedation, anesthesia, and/or any operation/procedure and that the risks/complications have been explained to me. I further understand that during the course of the operations or procedures, unforeseen conditions may arise that may necessitate the performance of additional procedures deemed necessary by the veterinarian. I am encouraged to discuss any concerns I have about these risks with the attending veterinarian before the procedure is initiated. I authorize the use of appropriate anesthesia and pain relief medication as needed before, during or after the procedure. I have been informed that there are risks associated with the use of any medication. The nature of these operations or procedures has been explained to me and I understand what will be done. I am aware that the practice of veterinary medicine is not an exact science and, thus, there are no guarantees for successful treatment. I have been encouraged and given the opportunity to discuss any questions I may have regarding my pet's medical care and my questions have been answered to my satisfaction. I accept that my financial obligations remain regardless of the outcome. I have read and understand this authorization and hereby accept and agree to the terms of the consent for treatment. Signature(Required)Name(Required) First Last Pet's Name(Required) Best phone number to reach you at today:(Required)CPR: In the event that %patientname% should experience cardiac or respiratory arrest while being hospitalized today, do you give consent for resuscitative efforts to be initiated until you can be contacted further and notified of %patientname%'s status? By consenting to this service, you are also acknowledging that certain fees will apply. If you are not able to be contacted immediately, resuscitation efforts will be continued to be performed at the doctor’s discretion. Please initial your choice below. I agree to CPR being performed in case of arrest (starts at $200 - includes catheter, fluids, and medications to help the body) I elect a “Do Not Resuscitate” status in case of arrest BLOOD WORK: Required for a C-section to ensure no complications with mom and to screen for any electrolyte problem I agree to blood work being performed prior to anesthesia to ensure the health of the pet IV CATHETER: Required for a C-section. This helps provide safer anesthesia, IV access for medications, and IV access in case of an emergency. I elect to have an IV catheter to placed to ensure there is venous access shall my pet have complications related to the procedure/anesthesia ($35) IV FLUIDS: Required for a C-section. These are used to help maintain blood pressure, heart rate, blood flow to the kidney/kidney function, and metabolize the anesthesia to make a shorter recovery time. I elect to have IV fluids performed while my pet is under anesthesia ($30) X-rays: Performed after the C-section to ensure there are not any puppies stuck in the pelvis/ hips which can not be palpated in surgery. ($80) I consent to a post operative X-ray I decline a post operative X-ray MICROCHIP I elect to have a microchip placed while my pet is under anesthesia ($40) I elect NOT to have microchip HOSPITALIZATION: Willoughby Veterinary Hospital is not an emergency clinic, which means we do not have overnight staffing. The only emergency clinic in the area is MSU. We are always more than happy to transfer a patient to MSU for 24 hour care and monitoring. In situations where the Dr. on staff feels your pet needs 24 hour care and feels your pet can stay at W.V.H. or financially transferring is not a possibility, we do keep patients overnight knowing there are inhered risks (pulling IV catheter, low body temperature, low blood sugar, fluid overload, etc) I understand that WVH does not have 24 hour staffing but approve overnight hospitalization if the doctor feels it is in my pets best interest and feels my pet is stable (this would be very odd in the case of a C-section- we only keep mom until she is recovered from anesthesia) LASER: Used to treat any inflammatory condition. The laser can greatly decrease pain and increase healing. Cost = $25 I would like my pet to receive a laser treatment after their procedure. I decline the laser treatment at this time. Progesterone Testing: Progesterone is a hormone that helps maintain pregnancy. Like all hormones it can fluctuate up and down during the day which means they can drop or vary depending on the time of day, so it is just a snap of a moment in time. C-sections are 100% ready when progesterone is <2.3, 2% chance that they will go into labor within 12 hours < 5.15 C-sections are best performed when we know the breeding date so we can know if we are in the conception window (day 58-63), and when the temperature drops <98F. We do not recommend a C-section until the progesterone is <4 (ideally 2). I approve having the progesterone measured I decline measuring the progesterone and understand, since WVH was not involved in the breeding, we will have no idea if the puppies are viable without performing this test. PICTURES: I APPROVE Willoughby Veterinary Hospital using any photographs or videos taken of my pet for social media or decoration at their discretion I do not approve the use of photographs or videos of my pet Please note, if your pet is having a spay or neuter, we do routinely apply a small tattoo on their abdomen which indicates they are fixed. Please note. If there is a health concern during your pets procedure, we do require that problem be addressed at the C-section. This includes: ear infections, skin infections, and allergies. Treatment is UP TO $200 and we will only do what is medically needed but is required. These mommas deserve to be properly cared for. Signature
