Orthopedic Surgery Consent Form

This surgery has been arranged by Eco Deco Pet Hospital and is being carried out by an external Referral surgical company. This company is called Gorostiza DVM, Inc., Dr. Jose Gorostiza is the Veterinary Surgeon and who will be carrying out the surgery. I understand that the surgery is being carried out by a third party and that my pet’s aftercare will be monitored by Eco Deco Pet Hospital who will have direct contact with Gorostiza DVM, Inc. Any follow up radiographs to monitor healing progress are an additional fee not included in the original surgical treatment plan. This agreement is in addition your practices own consent form that will also be signed on the day of surgery.

Cancellation/ Rescheduling Policy:
Your pet’s orthopedic surgery requires the coordination of authorization forms, the surgeon, the anesthesia nurse, and blocking off time from our appointments. Rescheduling requires significant time and expense, particularly if the operating room goes unused due to cancellation. We require a deposit of $1000 to schedule any orthopedic surgery. If you choose to reschedule your pet’s surgery, you must do so, 7-days prior to the surgical appointment. The $1000 surgery deposit will be forfeited for cancelling and/or rescheduling the surgery date, less than a 7-day notice. If the deposit for any reason was not received prior to the surgery date, a $1000 fee will be applied to your account for canceling and/or rescheduling with less than a 7-day notice. If you cancel the surgery a second time, the deposit will be increased to $1500.

Pre-anesthetic Testing:
A complete physical examination will be performed on your pet prior to the surgical procedure. However, a physical examination will not identify all systemic or metabolic problems. For this reason, we REQUIRE that your pet have pre- anesthetic bloodwork (and if 7 years or older chest x-rays) to evaluate major organ functions prior to anesthesia. Pre-anesthetic bloodwork is required to be performed 7 days before the surgical procedure. If diagnostics are not ran prior to the 7 days, the surgical appointment will be automatically cancelled at the client’s expense. If there are any abnormalities in the bloodwork or x-rays, the DVM will call you to discuss any changes to the original treatment plan. In other words, the surgery may be postponed, depending on the hospital’s availability. Bloodwork may only be honored for 7 days; therefore for any rescheduled surgeries, the patient will be required to re-run bloodwork at the client’s financial expense.

Medical History:
Patients staying for any length of time at our hospital must be current on their Rabies, Bordetella, & Distemper Parvo vaccinations. Owners and/or caregivers are expected to provide proof of vaccination at the time that the pet is brought to the hospital. If proper documentation is not provided or if the pet is overdue, the pet will be vaccinated accordingly at the owner’s expense. In addition, all dogs scheduled for surgical procedures must provide proof of heartworm testing and prevention. If appropriate documentation is not provided, the pet will be tested prior to the scheduled procedure at the owner’s expense. If your pet has fleas or ticks, it will be treated with a fast-acting flea and/ or flea/tick control while in our hospital. Fleas/ ticks are easily spread and put your pet and other patients at risk. If the DVM deems it necessary to administer Nexgard/ Capstar/ or Comfortis to your pet, you will be financially responsible.

Shaving:
The surgical site will be shaved to create a sterile area. A small area on a leg will be shaved to facilitate the placement of an IV catheter.

Drop Off/Pick-Up:
Drop off for surgery is between the hours of 8am-8:30am Monday – Friday and Saturday at 9am. We do require a minor physical examination at the time of drop off by our Pet Nurse; please allot time in your schedule. The patient must be fasted overnight. Please pick up and/ or remove any food left out for your pet by 12:00pm the night before surgery (except Rabbits). Water can be left out for pets to drink.

You will be contacted after the surgery is completed to schedule a pick up time by text or phone. Please be aware that you must pick up your pet even if not contacted, prior to our closing time. If you are unable to get your pet at the designated pick up time it is your responsibility to contact Eco Deco Pet Hospital to make arrangements. If you cannot come get your pet and the pet has to remain overnight, a boarding fee of no less than $40 per night will be charged. It is your responsibility to make arrangements to pick up your pet by the designated pick up time. A late fee ($150) will be assessed 30 minutes after the designated pick up time.

Elizabethan Collar:
To ensure that your pet will not chew or lick open the surgical site, an Elizabethan collar is recommended. The pet is required to wear it at all times after the surgery until the post-surgical appointment date. If you decline or do not use the Elizabethan collar, the pet may open the incision, cause infection or may injury itself. Any post-surgical complications will be at the owner’s expense if the Elizabethan collar was declined or not used properly.

Acknowledgment and Consent of Surgical Risks
I hereby authorize Gorostiza DVM, Inc. to perform the surgery that has been explained to me, to my satisfaction. I acknowledge that I am the owner and/ or the appointed caregiver of the pet. I understand that any anesthesia poses a risk to my pet, regardless of health status and will not hold Eco Deco Pet Hospital liable for any post-surgical complications. In the event of unforeseen complications, I give permission for the doctors and staff to take reasonable measures in treating my pet and accept all charges that are incurred as a result of such action. As the owner and/ or appointed caregiver will pay for the balance in full upon discharge of my pet. The anesthesia, aftercare and relevant costs have been fully explained to me to my satisfaction.