Procedure Consent Form

Please fill out this online consent form, and click submit, at least 48 hours before your pet’s procedure.

Fasting Instructions

Unless your vet has given you specific instructions, pre-op fasting guidelines are as follows:

Dogs & cats over 3 months of age, and over 2kg body weight, should be fasted for 8 hours prior to general anesthesia. (Fasted means no food.)
Rabbits (+ puppies & kittens younger than 3 months of age or smaller than 2kg body weight) are exceptions. These patients should not be fasted.
Water should not be withheld prior to admitting to the hospital.

Full Name *

Email Address *

Phone Number on the day of the Procedure *

Alternate Phone Number

Pet's Name *

Scheduled Procedure *

Pre-op fasting: *

I have read the fasting instructions above, and ensure my pet will be fasted for their procedure
I have received specific instructions from the vet and will follow those
No, my pet will not be fasted. (We may not be able to proceed if your pet is not fasted.)

A full examination will be performed (and charged) on surgery day, if we have not examined your pet within the last year. *

I understand. (Questions may be typed into comments box at the bottom of form)

If fleas are seen on your pet, a short-term treatment will be administered, and there will be a nominal fee.
(If your pet does not have fleas, don't worry. In that case, there will be no action taken.)

Pre-op Bloodwork: The fee for this testing is $150.00. Click here for more information on bloodwork.

Would you like your pet to have the following identification placed? *

A tattoo (in the right ear) for identification, helpful within B.C.
A microchip for identification worldwide
Both a tattoo & a microchip
No thank you. Neither.

Is your pet on a special diet? *

No special dietary needs.
I feed my pet raw. (We need to know this so we can take precautions for immune suppressed individuals.)
My pet is on a special diet. Please do not feed my pet any food or treats unless discussed.

In the event that your pet experiences cardiopulmonary arrest (a sudden loss of heartbeat and breathing), our medical team requires your direction on whether to initiate life-saving resuscitative efforts (CPR) or to follow a Do Not Resuscitate (DNR) order.

DNR (Do Not Resuscitate) means that in the event of cardiac or respiratory arrest, no attempts will be made to revive your pet. Click here for more information on CPR/DNR.

We understand that this is a deeply personal decision. If a cardiopulmonary arrest occurs, we will make every effort to contact you immediately, provided it is safe to do so. However, we must have your prior authorization to act according to your wishes in a timely and medically appropriate manner.

Please review and select one of the following:

Perform CPR: I authorize the veterinary team to perform all medically indicated life-saving measures in the event of cardiopulmonary arrest. (Additional emergency fees may apply, approx. $300–$500)
Do Not Resuscitate (DNR): I do not authorize any resuscitation efforts in the event of cardiopulmonary arrest.

I give consent for my pet, named above, to have the scheduled procedure, and for vets/staff of Bellevue Veterinary Hospital to carry out any treatment that is necessary. I realise that no guarantee can be made regarding outcome/cure. I am aware of the risks of the general anesthesia and/or the procedure. If I have questions, I will ask them. I will be responsible for the fees charged for this service and for following the post-op instructions for my pet.

Procedure Consent Form

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