Information and Consent for Surgical Treatment

Thrive Affordable Vet Care

1299 Northside Dr Suite 610,Atlanta,GA,30318
(404) 994-4166

Name of Pet: ​____________________________________________

Name of Owner: ​_________________________________________
Date of Surgical Procedure:​ _________________________________________
Services/Procedures we are doing for your pet today: ​______________________
Best phone number to reach you at today:​__________________________________

Your pet has been scheduled for an upcoming surgical procedure. To best assist you,
we have put together this packet to ensure that your surgery day is made as easy and
stress-free as possible. Therefore, please review this packet carefully.

Prior to any pet undergoing a surgical procedure, we always require blood-work to be

completed to ensure that your pet is healthy enough to undergo anesthesia/sedation. If
your pet has not had this done yet, please make an appointment to have this testing
done before the procedure.

Please ensure that your pet is dropped off between 8:00 am - 8:30 am the morning of
your pet’s scheduled procedure. If this time frame is not feasible, please let us know in
advance and we are more than happy to make other arrangements.

We will always call you before we begin your pet’s procedure and we will always call
you when we are done. If anything comes up during the procedure that deviates from
the initial plan/estimate, we will also call you to discuss this. If we are unable to reach
you, your veterinarian will do what is medically necessary for your pet. Needless to say,
you are always more than welcome to call us to check on your pet’s status at any time.

THE NIGHT BEFORE YOUR PET’S PROCEDURE:

● Please do not feed your pet any food or treats after 10 pm. Water is OK.
● If your pet is on any oral medications, vitamins, please do not administer them
the morning of the appointment unless otherwise instructed by your veterinarian
● Please take your pet for a walk in the morning of the procedure to encourage
them to use the bathroom
 Information and Consent for Surgical Treatment
Thrive Affordable Vet Care
1299 Northside Dr Suite 610,Atlanta,GA,30318
(404) 994-4166

DURING YOUR PET’S PROCEDURE:

Dental Procedures: ​Please initial
● I authorize my pet's veterinarian to extract teeth as they deem necessary,
understanding that extractions will cost extra ​___________
● I ​DO NOT​ authorize my pet's veterinarian to extract any teeth without my
consent. Please call me at ​________________________​ to discuss my pet's
needs during the procedure. If I am unavailable during this call I understand my
veterinarian will not extract any teeth ​________________

Microchip: ​Please initial

● I authorize Thrive Affordable Vet Care to implant a microchip (permanent
identification) into my pet. The fee also includes lifetime registration for your pet
($35.00) ​_______________
● My pet already has a microchip. Please add the number to the file ​___________
● I ​DO NOT​ authorize Thrive Affordable Vet Care to implant a microchip
(permanent identification) into my pet ​_______________

Nail Trim (additional $15)​: Please initial

● Yes​ _________
● No ​__________

CPR (Cardiopulmonary Resuscitation):

In the event that your pet 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 your pet’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 cardiac arrest ______________________

I elect a ​“Do Not Resuscitate” ​status in case of cardiac arrest ___________________

 Information and Consent for Surgical Treatment
Thrive Affordable Vet Care
1299 Northside Dr Suite 610,Atlanta,GA,30318
(404) 994-4166

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.

Printed Name: ________________________________________________________

Signature: ___________________________________________________________

Date: _______________________________________________________________