Complex Procedure Consent
I, ____________________________________________________________________________________
Address: ______________________________________________________________________________
declare that I am the owner/or duly authorised agent (circle one) of:
Pet's Name: ____________________________________________________________________________
Breed:
Age:
Sex:
and that I hereby consent to the following procedure: ___________________________________ _____
My pet was last fed at __________________________________________________ (Time and date)
For Procedures, Anaesthesia, and/or Surgery, the following statement needs to be authorised:
I understand and acknowledge the following:

I understand, authorise and request that the advised procedure is carried out.

All procedures (especially more complicated, non-routine procedures) may result in unexpected
complications and outcomes.

If unexpected complications occur, the situation will be reassessed and further treatment options
will be discussed with me. Any further treatment costs will be my responsibility, either during or
following the procedure, either by my veterinarian or a veterinary specialist.

In the unlikely event of an accident or emergency during the procedure, immediate lifesaving
surgical or medical intervention may be required. In that situation, I authorise the practice to take
every reasonable action to control and rectify the problem.

I understand I will be liable for all costs associated with emergency treatment. The practice will
attempt to contact me, on the contact phone number that I have given, to discuss options as soon
as is reasonably possible.

I also give permission for the veterinarian to use human medicines on my animals or to use
veterinary medicines in ways other than their labeled use if the veterinarian believes this is
necessary.

My veterinarian is not a veterinary specialist in this area of veterinary medicine/surgery.

I have declined referral to a veterinary specialist for this procedure.

The procedure, together with possible risks and potential complications, as well as the expected
outcome, has been explained to me, to my satisfaction.
OR:
I would like to discuss this further with the veterinarian before work is commenced, and will then give
my consent to the above conditions verbally. Signed ________________________Date _________
The estimated fees for the procedure of $_________________ have been explained to my satisfaction.
I authorise pre anaesthetic blood testing to be performed, at an additional cost of $________________ if
required.
I will be paying: In full when my animal is released to me / please charge on my monthly account
Or other [detail here] __________________________________________________________________
I have the authority to sign this consent.
Signed ______________________________________ Date :
Emergency contact ____________________________
Complex Procedure Consent Form
December 2012
Page 1 of 2
Anaesthesia & Surgical Risks
There are risks associated with any anesthetic or surgical procedure. Any risks are minimized through
careful clinical assessment of your pet and preparation of your pet prior to anaesthesia.
Pre Anaesthetic Preparation
Healthy adult pets can be fed up to 8 hours prior and have access to water up to 2 hours prior to
anaesthesia. In general, please feed a light meal the evening before and remove water on the morning
of the anaesthetic. Your pet will receive a full clinical examination before the procedure and pre
anaesthetic blood and urine tests may be recommended. If your pet is not in good health, the procedure
may be postponed.
Anesthesia / Sedation
Anaesthetic is administered by injection into the muscle or vein. Hair will be shaved from the injection
site. A tube is placed into the wind pipe to give the anaesthetic gas and assist breathing if this is
necessary. Almost all anaesthetics go smoothly, and although every care is taken to ensure the safety of
your pet, very occasionally problems can arise.
Surgery
As with anaesthesia, there are risks and complications associated with surgery.
It is important that the surgical procedure has been discussed fully, and any post operative conditions
explained to your satisfaction. These can include wound discomfort and swelling, wound breakdown,
infections, nausea, vomiting, shivering, itchiness and in very rare cases death. Every effort is made to
minimise these risks, through surgical technique and post operative care of your pet. Drugs may be
prescribed for pain and infection. If you have any concerns about the anaesthetic or procedure, please
discuss these with your veterinarian.
Post Anaesthetic Care
After an anaesthetic your pet may be sleepy, and will feel the cold. If your pet seems very drowsy or
unwell, or you have any questions or concerns after the anaesthetic procedure, do not hesitate to
phone your veterinarian.
It may take up to 36 hours for your pet to be fully recovered, during which time they must be confined
in a warm, dry place.

Cats should not be allowed outside, so a litter tray will be required for them.

Dogs should preferably be kept inside, or in a warm kennel or garage.

Offer your pet a small meal on the evening following the anaesthetic, as a large meal can cause
vomiting.

Ensure they have access to fresh water.
Complex Procedure Consent Form
December 2012
Page 2 of 2