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Surgical / Anesthesia Consent Form

Address
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Would you like a pawdicure performed (nail trim) $12.75?
Would you like your pet to have a microchip implanted (includes registration) $44?
Would you like an anal gland expression while under sedation/anesthesia $21.50?
Would you like your pet to receive pre-anesthetic bloodwork?
(for pets under 6 years old, if your pet is older than 6 years we will require this bloodwork for surgery)

I, the undersigned owner or agent of the pet identified above, authorize the veterinarian and staff of Blue Oasis Pet Hospital to perform the above procedure(s). A complete physical exam will be performed on your pet prior to the surgical procedure if it has been longer than 30 days since the last exam. However this may not identify all systemic or metabolic problems. For this reason, we highly recommend and may require a pre-anesthetic blood panel to evaluate major organ functions prior to anesthesia in all pets.

I understand that some risks always exist with anesthesia and/or surgery and that I am encouraged to discuss any concerns I have about those risks with the doctor or the BOPH healthcare team before the procedure(s) is/are initiated. With risks being understood, I will not hold the Blue Oasis Pet Hospital, its doctors or staff liable for any unforeseen circumstances including unexpected complications or death due to anesthesia. Pain control will be given to your pet to manage his/her recovery. We also recommend that our patients have pain control for healing time at home. Optimal healing is obtained with proper pain management.

I understand that the attending veterinarian will make every effort to contact me regarding treatment in the case of unforeseen emergencies. If unable to contact me, the staff may or may not have my permission to proceed with life sustaining procedures:

While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I
understand that no guarantee or warranty has been made regarding the results that may be achieved.
I also assume full responsibility for any additional expenses incurred after the surgical procedure is
performed, such as follow up radiographs, re-check physical exams and additional surgery due to post-op
complications. These are more likely to occur when there is a failure to comply with the aftercare instructions.
I understand that the Blue Oasis Pet Hospital is not a 24 hour hospital and there is no staff at the hospital
overnight. For this reason, if my pet needs to be hospitalized overnight after anesthesia/surgical procedure/medical
condition, the Blue Oasis Pet Hospital will require that my pet be transferred to a 24 hour/overnight ER hospital for
observation. If transfer to a 24 hours/overnight ER care clinic is refused, I will not hold the Blue Oasis Pet Hospital,
its doctors or staff liable for any events, including any medical complications or death. I understand that if I refuse to
transfer, I may be required to sign an Against Medical Advice (AMA) form.
I have read and fully understand the terms and conditions set forth above.

*We require confirmation of surgical appointments 48 hours prior to the scheduled procedure. All surgical no-shows or last-minute cancellations (less than 48-hour notice) must pay a $100 deposit to reschedule the surgery.*

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  • 200 Crossings Lane, Suite 400
    Mount Juliet, TN 37122
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