Pre-Anesthesia Consent Form

Name: O'Neal Lane Pet Hospital
Address: 650 O’Neal Lane, Baton Rouge, LA, 70816, United States
Telephone: 225-273-0579
Price range: $

Thank you for choosing O’Neal Lane Pet Hospital! Please fill out the form as completely and accurately as possible.

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Pre-Anesthesia Consent Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. If this is an emergency, or if your pet needs urgent care, please call us at 225-273-0579 for a faster response.

Client Name *

First

Last

Patient Name *

Phone number at which owner can be reached today or tomorrow: *

Additional number

Email *

Before Procedure:

Would you like to be contacted before your pet goes in for the procedure *

Would you like to be contacted by text or phone call before the procedure? *

Text
Call
Either

If text, what number would you like to be texted at?

After procedure:

Would you like us to text you after the procedure, or would you prefer a call? *

Text
Call

Anesthetic and surgical procedure(s) to be performed: *

I, the undersigned owner or agent of the pet identified above, authorize the staff of O'Neal Lane Pet Hospital to perform the above procedure(s). *

I have read and agree

Microchip: *There is an additional fee for this procedure* *

Yes
No
Already has one

Have you given your pets any medications or supplements in the past week? *

Yes, Other medication(s), please specify below
No

Other medication(s), please specify and note last time given

We require bloodwork before all surgery. We offer two options: (1) A pre-surgical panel ($65) or (2) A senior panel ($178 - includes thyroid and urinalysis). Please select one option below: *

Pre-Surgical Panel
Senior Panel

When was the last time fed?

Any other concerns/allergies/procedures?

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 attending veterinarian before the procedure(s) is/are initiated. *

I have read and agree

I am over 18 and 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. *

I give my permission [yes]
I do not give my permission [no]

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 have been provided an estimated cost for the procedure(s) listed above. I assume financial responsibility for the recommended services and will provide payment in full at the time my pet is discharged from the hospital. I have read and fully understand the terms and conditions set forth above. *

I have read and agree

Signature *

Date *

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Contact Us

Address

650 O'Neal Lane
Baton Rouge, LA 70816

Contact

Phone: 225-273-0579
Fax: 225-273-7702
Email: [email protected]

Hours of Operations

Monday - Friday: 8:00am-5:00pm
First & Third Saturdays: 8:00am-12:00pm
Sunday: Closed

Got Questions?

Let’s get in touch! Fill out our contact form and a member of our team will be in touch shortly. If you need immediate assistance, please feel free to call us.

Name *

First

Last

Email *

Phone

How can we help you? *

Phone