PROFESSIONAL AND PERSONAL SERVICE FOR YOU AND YOUR PETS
GARY R. SARGENT, DVM 960 WEST MOANA LANE, SUITE 102
ERIN L. RASMUSSON, DVM RENO, NEVADA 89509
WWW.SWVHRENO.COM (775) 825-SWVH
SOUTHWEST VETERINARY HOSPITAL ANESTHESIA CONSENT
The goal of Southwest Veterinary Hospital (SWVH) is to provide a standard of excellence in
patient care in a modern, fully equipped, small animal hospital. A hospital that is
comfortable for our patients, attractive to our clients and a pleasant workplace for the
doctors and support staff. Thank you so much for choosing SWVH. We understand that you
have many options when it comes to the care and treatment of your dogs and cats. We
appreciate the opportunity to show you what we do best.
INHERENT RISK: There are inherent risks involved with any type of anesthetic, surgical or invasive
procedure including, but not limited to, anesthetic complications, surgical wound infections, surgical
procedural failure, and even the untimely or unanticipated death of a patient. The SWVH staff are
committed to achieving 100% success in every anesthetic or surgical procedure performed; however, no
outcome can be guaranteed 100%.
PROCEDURAL FEES: Surgical/procedural fees are an estimate only. Unanticipated events occasionally
occur, which may require additional anesthetic time, additional surgical materials, prolonged or intensive
postoperative care, etc. Your doctor will keep you apprised of any changes in the estimated fee for your
pet’s procedure. Please understand that follow-up radiographs, bandage or splint changes, surgical
implant removal, and professional fees (if indicated) for future visits are charged at our regular and
customary fees beyond estimated surgical/procedural fees. All fees are due at the time of discharge.
ANESTHETIC CODE: All patients are continually monitored throughout anesthesia procedures. Very
rarely a patient may arrest (causing heart beats and/or respirations to cease) during an anesthetic
procedure or because of a serious medical condition. SWVH staff needs to know whether you want
closed C.P.R. (cardio-pulmonary resuscitation) performed on your dog or cat and be responsible for the
costs incured. The doctor can explain what typically happens during a code.
Yes, perform C.P.R. _______ No, do NOT perform C.P.R. _______
I do hereby consent to surgery and treatment by Southwest Veterinary Hospital as may be
necessary for my pet’s injury or condition. I have been informed of the attendant risks and
options of surgery, procedure or treatment and understand the services as stated.
Signature: _________________________________ Patient: _______________ Date: __________
Procedure: ____________________________________________ Estimate: ______________________
Contact phone numbers: (H) ___________________ (W) _________________ (C) _________________