Surgery & Anaesthesia Consent Form
This form explains the procedure your pet is scheduled to undergo, the risks involved, and the decisions we need from you before we begin. Please read each section carefully and ask our team if anything is unclear.
Section 1 — Patient & Procedure
Weight on day of surgery:
Section 2 — Pre-Surgical Fasting
To reduce the risk of vomiting and aspiration under anaesthesia, dogs and cats should not eat solid food after midnight the night before surgery. Water is usually fine until drop-off. Rabbits, guinea pigs, and small exotics should NOT be fasted — please confirm with our team.
Time of last meal / water:
Section 3 — Anaesthesia Risk Acknowledgment
Anaesthesia is necessary for safe surgery but carries inherent risk, which is increased in senior pets, brachycephalic (flat-faced) breeds, and patients with underlying disease. Our team will monitor heart rate, respiration, oxygen saturation, blood pressure, and temperature throughout the procedure.
Section 4 — Optional Add-On Services
While your pet is under anaesthesia we can often perform additional services more safely and economically. Please indicate whether you would like any of the following:
Section 5 — Resuscitation Preferences
In the unlikely event of cardiac or respiratory arrest, please indicate your preference. CPR in veterinary medicine has roughly a 5–10% success rate and can result in rib fractures or neurological damage even when successful.
Section 6 — Reaching You During the Procedure
Best phone number during surgery:
Secondary number if we cannot reach you:
If we discover something unexpected during surgery and cannot reach you, please indicate your preference:
Section 7 — Authorisation
Thank you for trusting us with your pet. We will call you as soon as the procedure is complete.
Authorized representative — printed name:
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