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Hours 840 E Main St
Midlothian, TX 76065

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Call: (972) 775-2901
Hours
About Us
Services
Alternative Care
Boarding
Pet Corner
Contact
Download Our App
Careers

Surgical Consent Form

Patient Name*

What is the best way to reach you today?*

Surgical procedure to be preformed:*

Your pet will be undergoing general anesthesia plus a surgical procedure today. To recognize any underlying abnormalities your pet may have, we recommend having a pre-surgical blood profile run on your animal. This consists of a check of the ELECTROLYTES, CBC, which will check blood cells, and an ALT, ALKP, CREA, GLU, TP, and BUN, which will check blood glucose, kidney and liver enzymes. These blood tests will help us to assess the health status of your pet more completely and determine if there are any additional precautions we need to take before surgery.

We highly recommend a blood profile for animals over 5 years of age and is required for animals over 7 years.

There is an additional charge of $157.82 for these blood tests. We hope you understand the need for these important tests.*

Yes

No

I fully understand the risk of anesthesia and the importance of pre-surgical blood work to determine any underlying problems. I will not hold Midlothian Veterinary Clinic responsible if I choose to decline to run pre-surgical blood work.*

Yes, please run pre-surgical blood work.

No, I understand the risk of anesthesia.

No, the Patient has had labwork within the last 30 days.

I am the owner, or representative of the owner, of the animal presented and have the authority to execute this consent.
I understand that current vaccinations (including Bordetella) are required for all pets entering the hospital. If vaccinations are not current, they will be updated at the doctor's discretion.
I have been advised as to the nature of the procedures and the risks involved. I realize that the results cannot be guaranteed.
I hereby consent and authorize this hospital to perform the above anesthetic and procedures and/or surgery.
I understand the doctor and staff will use all reasonable precautions against injury, escape, and/or death of my pet.
I understand that all anesthetics involve some minimal risk to my pet and I will not hold the doctor or staff responsible under any circumstances. I understand that I assume all risks.*

Yes

No

Microchip Implantation $73.01*

Yes

No

Laser Therapy (Post-Op) $25.49*

Yes

No

Midlothian Veterinary Clinic

840 E Main St Midlothian, TX 76065 email: midlothianvetclinic@yahoo.com phone: (972) 775-2901

Proudly serving Midlothian, TX and the surrounding areas.

Office Hours

Monday: 8:00 AM - 6:00 PM*

Tuesday: 8:00 AM - 6:00 PM*

Wednesday: 8:00 AM - 6:00 PM*

Thursday: 7:00 AM - 7:00 PM*

Friday: 8:00 AM - 4:00 PM*

Saturday: Closed

Sunday: Closed

*We close daily from 12:00 PM-1:00 PM for lunch

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