St. Augustine Humane Society · Anesthesia/Surgery Consent Form

Contact Information

YOU MUST SPEAK WITH A HUMAN ABOUT SCHEDULING SURGERY BEFORE YOU FILL OUT THIS FORM. You can not schedule your own appointments through our website and you will be required to give us the check in CODE # when you check in that we provided at the time of scheduling your pets surgery.

Client Name *

First Name

Last Name

Client Phone Number *

Client Email *

We require that all clients provide a valid email address. This is where microchips are registered, all documents and records will be sent, such as receipts, release forms, after surgery care instructions, and other important documents. If you do not have an email address, please create one before filling out this form.

Verify Email *

Pet's Name *

IMPORTANT NOTE: Each pet must have a separate Anesthesia/Surgery Consent Form filled out.

Surgery Code Number *

This 4 digit code is given to you when we discuss the scheduling of your pet and set the date with you. If your pet is scheduled for surgery and you do not have this code #, please contact cbessett@staughumane.org

Appointment Date Given to You by the SAHS Staff **YOU DO NOT CHOOSE YOUR OWN DATE** *

SELECTING A DATE DOES NOT MEAN YOU ARE NOW ON OUR SCHEDULE. If you have not formally spoken with a staff member and do not have an appointment date, email cbessett@staughumane.org to schedule an appointment (if you have filled out our new client/pet form).

Anesthesia/Surgery Consent

The St. Augustine Humane Society (SAHS) uses qualified staffing and approved materials for all procedures performed. It is important for you to understand that the risk of injury or death, although extremely low, is always present, just as it is for humans who undergo surgery. Carefully read and understand the following before signing your name:

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I, acting as owner or agent of the pet named below, hereby request and authorize SAHS, through whomever veterinarians they may delegate, to perform an operation for sexual sterilization of the animal named below, and/or anesthsia plus the procedure described on estimate.

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I understand that anesthesia, surgery, vaccination and other therapeutic or diagnostic procedures may involve risk of complication, injury, or even death, from both known and unknown cases.

Proof of Rabies Vaccination *

I have proof of rabies.

I do not have proof of rabies and consent to vaccination of my pet.

I understand the risks of failing to maintain current vaccinations and understand that my pet may be exposed to animals who are carrying infectious diseases. Our policy is to HIGHLY RECOMMEND full vaccination prior to surgery. *

Initials

I decline pre-op bloodwork which may detect hidden illness(es) in my pet. *

Initials

I understand that post-op care is my responsibility. Should my pet require emergency care from a vaccine reaction or any other complication, I will seek medical care at my own expense. *

Initials

I understand that during the course of surgery, I must be available by phone. However, if I can't be reached, I authorize the surgeon to perform any remedies for serious conditions. These procedures may be subject to additional fees. *

Initials

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I have read and understand the after-surgery care instructions.

*

I either certify that my animal is current on his/her vaccinations, or waive my right to protect my animal by having it vaccinated prior to hospitalization, or request recommended vaccinations at the time of surgery. I understand that it takes up to two weeks for vaccinations to protect my animal from infectious disease.

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I certify that my animal is in good health and has had no food since 8:00pm the evening prior to surgery.

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I understand that some conditions increase surgical risk, including, but not limited to, obesity, pregnancy, heat, and Feline Immunodeficiency Virus (FIV), Feline Leukemia, and heartworm and tick-borne diseases. Today's pre-anesthetic exam will be limited to confirming that your pet is in the lower-risk category for anesthesia and/or surgery. Complete health assessment including pre-anesthetic blood work, fecal testing, heartworm testing, FeLV/FIV testing is available in the SAHS Veterinary Clinic, but must be done prior to hospitalization. Today's selected services will be performed after sedation in most cases.

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I understand that if my animal is pregnant, the pregnancy will be terminated at surgery.

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I understand that if my animal requires additional surgery as a result of an additional condition, I will be charged an added fee. Conditions may include the following: umbilical hernia, cryptorchid male, late term pregnancy, or other urgent conditions. Flea infestations may be treated with Capstar, at an additional cost, to minimize exposure to other animals. I understand that if I don't retrieve my pet at the agreed upon time, I shall be charged a boarding fee of no less than $25 per night.

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I hereby release the St. Augustine Humane Society (SAHS), all veterinarians, assistants, volunteers, directors, and employees from any and all claims arising out of or in connection with the performance of this procedure or any adverse complications. I agree that I have not and will not claim any right of compensation from the SAHS. I hereby agree to indemnify and hold the SAHS harmless for any damages caused during the handling of the animal, or for any damages caused by any unforeseeable events including fire, vandalism, burglary, extreme weather, natural disasters, or acts of God.

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I understand that my animal will receive a small tattoo on his/her underside to show that he/she has been sterilized.

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I will follow post-operative instructions not limited to: avoidance of stairs, jumping, playing, any off leash activity, and avoidance of swimming/bathing for 10-14 days. Confinement to a crate is recommended for high energy pets. I will give every effort to prevent licking of the incision not limited to placement of a cone.

Media Release *

The St. Augustine Humane Society uses pictures of pets we serve to spread awareness for our mission and programs. We will never release personal information without the permission of the pet owner.

My pet's picture may be used.

My pet's picture may not be used.

Electronic Signature *

Prefix

First Name

Last Name

Suffix

Electronic Signature Date *

(mm/dd/yyyy)

HOW TO CARE FOR YOUR PET AFTER SURGERY

After Hours Emergency Vet Phone Number (until 9:00pm): 904-770-9821

Thank you for bringing in your pet for sterilization. You are helping end the pet overpopulation problem. Since our clinic is not staffed 24 hours a day we ask that you, the owner and caretaker, monitor your pet to provide the best possible care. Please carefully read the post-op instructions. We cannot be held responsible for circumstances resulting from failure to follow these instructions.

No running, jumping, playing, swimming, or other strenuous activity for 10 to 14 days. Keep your pet quiet. Pets must be kept indoors where they can stay clean, dry, and warm. No baths during the recovery period. Dogs must be walked on a leash and cats must be kept indoors. No Baths.
Check the incision site twice daily. There should be no drainage. Redness and swelling should be minimal. Do not allow your pet to lick or chew at the incision. If this occurs, an E-collar MUST be used to prevent additional licking and chewing that could cause infection. There will be a FIRM LUMP under the incisions as the absorbable sutures are breaking down for 1 – 2 weeks. This is normal. THERE ARE NO EXTERNAL SUTURES, unless otherwise noted.
Pain Medication. If you chose to purchase post-operative pain medication, you may start the first dose the next day after surgery.
Appetite should return gradually within 24 hours of surgery. Do not change your pet’s diet at this time, and do not give them junk food, table scraps, milk, or any other people food during the recovery period. This could mask post-surgical complications.
We recommend that your pet receive an exam with your regular veterinarian 7 to 10 days after surgery, to have the incision checked for complete healing, to remove any skin sutures, and to discuss additional needs, follow-up care, and vaccine boosters. Dogs may have a slight cough for a few days after surgery.

**After 9:00 pm the night of surgery, refer to the following:
If there are any questions or concerns directly related to the surgery during the recovery period, please call this office at 904.829.2737. If there is an emergency, contact your regular veterinarian or REACH a local Emergency Hospital. SARVAC at 904-797-5770 or Animal Emergency Hospital of St. Johns at 904.794.5071. Fees incurred at a location other than our clinic are your responsibility. Your regular veterinarian must address illness or injuries that are not a direct result of surgery.

Our Wellness Clinic is open every Wednesday and Thursday. Please don’t hesitate to call or bring your pet to the clinic if you have concerns. 904.829.2737

It is normal for your pet to be quiet and reserved for several hours after surgery. However, the following conditions require immediate attention:

Excessive Bleeding. Small droplets of blood can be normal. However, if it is a steady flow please call your vet or go directly to the emergency vet.
Breathing Difficulty. If your pet seems to have trouble breathing or if breathing is especially shallow, this could be an emergency situation. Please call your vet or go directly to the emergency vet.
Lethargy lasting for more than 24 hours post-op, diarrhea, or vomiting are not normal and your pet should be taken to your regular vet.

Your pet received a GREEN TATTOO next to his/her incision. This tattoo is a scoring process in the skin; IT IS NOT AN EXTRA INCISION.

FERAL CAT DISCHARGE AND RECOVERY INSTRUCTIONS

After Hours Emergency Vet Phone Number (until 9:00pm): 904-770-9821

ALLOW THE CAT TO RECOVER OVERNIGHT IN THE SAME TRAP

While the cats are recovering from anesthesia they are unable to regulate their body temperature. It’s important that the recovery location is temperature-controlled to keep the cats from getting too hot or too cold. A basement or bathroom will usually do the trick. The cat will display wobbly movements and shivering while waking from the anesthesia.
Let the cat recover overnight in the same trap. Keep the traps covered to reduce the cat’s stress. Place newspapers or towel under the trap to absorb urine and feces.
Keep the cat indoors in his covered trap and make sure he is dry and away from loud noises or dangers such as toxic fumes, other animals, or people.
Never open the trap doors or allow the cat out of the trap. Do not stick your fingers through the bars or attempt to handle the cat.

MONITOR THE CAT

Monitor well to ensure that cat is breathing normally and is not bleeding from the surgical site or ear tip site. It is normal to have a small amount of bleeding from the ear tip. It should stop by the next morning.
DO NOT try to handle the cat (this includes putting pain meds in the mouth)
All skin sutures are absorbable and do not need to be removed.
Check the cat often for progress; If a cat is vomiting, bleeding, having difficulty breathing, or not waking up, get veterinary assistance immediately.
If a cat is vomiting while still unconscious, his head should be turned to avoid choking. Sometimes this can be achieved by gently tipping the trap to no more than a 30 degree angle to change the cat’s position. Be careful when tipping the trap so that you don’t harm the cat by jostling him too much.

FEED AND PROVIDE CATS WITH WATER AFTER THEY REGAIN CONSCIOUSNESS

Cats can be fed shortly after waking from anesthesia and settled in. When the cat is awake, mix canned food with water, roll into ball, and drop into trap.

HOLD CATS UNTIL THEY RECOVER

Cats usually need to be held for 24 hours after surgery, depending on recovery speed. Cats can be returned to the trapping site 12-24 hours following surgery as long as they are fully awake and do not require further medical attention. Females may need 48 hours of recovery, depending on their specific circumstances.
Make sure all cats are fully conscious, clear-eyed, and alert before release.
If the cat is not recovering well from surgery for any reason (longer than 48 hours) and needs further care please seek medical care.

RETURN THE CAT

Cat needs to be fully awake and alert before it is released. Be sure it does not require any further medical care before releasing from trap.
Only release cat from trap at dawn or dusk. Release the cat in the same place you trapped him or her.
It is not uncommon for a cat to “disappear” for a few days after she is returned. She will appear eventually. Continue to provide food and water—she may eat when you are not around.