810-965-6826 [email protected]

Home
About
- Our Story
- Our Team
- FAQs
Services
Resources
Pharmacy
Contact Us
Appointment

Select Page

Abdominal Exploratory Form

Save time during your next appointment! Complete your required forms online from any device at any time before your scheduled appointment.

“Bringing specialized veterinary surgical services to you!”

Jacqueline J Mair
DVM,MBA, Diplomate ACVS

SCHEDULE TODAY!

mss - abdominal exploratory

Abdominal Exploratory Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before the procedure.

Date *

Client Details

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone *

Secondary Phone

Email *

Animal Details

Name *

Species *

Cat
Dog

Breed *

Age *

Sex *

Male
Neutered Male
Female
Spayed Female

Weight *

Your Pet has been admitted for None Specified

Has your pet eaten after 8pm last night? *

Yes
No

Has your pet had any medication recently? *

Yes
No

Your pet has been recommended to receive an exploratory surgery to identify abnormal contents within the abdomen (intestinal foreign body, mass or tumor, abscess, puncture wound, etc). The objective of surgery is identify any abnormal areas or sections of organs and remove them. Often times, more than one area is affected, however one specific organ or section of an organ can be affected only. The goal during surgery is to identify the abnormal contents within the abdomen and remove all or most of the abnormal contents or section of intestine that might be affected. This may require numerous incisions within the intestine or organ or removing a section of intestine or entire organ. Other organs within the abdomen can be affected and may need to be removed as well like Gastrointestinal tract, Urinary tract, Liver, Spleen, Pancreas. Many different surgical techniques are available to the surgeon but using a variety of suture or stapling equipment, the abnormal section will be removed or debulked as necessary. Other intestinal organ biopsies may be warranted. Although every effort is made to prevent or minimize complications, any surgery near these important structures are not without complications. I consent to the selected surgical procedure(s). *

I have read, understand, and consent.

I hereby authorize the admitting veterinarian (and his/her designated associates or assistants) to administer such treatment as is necessary to perform this procedure. The nature of the procedure(s) has been explained to me and no guarantee has been made as to results or cure. I understand that there may be risk involved in these procedures. I consent to the administration of such anesthetics or tranquilizers as are necessary. *

I authorize.

Anesthetic Risks: (Although every effort is made to make anesthesia as safe as possible including vital sign monitoring and use of the most up to date anesthetic agents and equipment, understand that anesthesia has inherent risks). The incidence of complications from anesthesia is extremely low and we do not anticipate any in your pet but on rare occasions the following can occur: 1. Allergic reaction to the anesthetic agents 2. Heart rhythm abnormalities 3. Untoward reactions to the gas including drops in blood pressure or respiratory difficulties 4. Just like in humans, on very rare occasions, general anesthesia can result in death. *

I have read and understand the risks.

Surgical Risks Include: 1. Infection (less than 3%) which may require additional testing and medication at an additional cost. 2. Blood clots that can lodge in major organs causing stroke or rarely death. 3. Splenectomy for a cancerous process is not a cure for the disease. Patients will require ongoing therapy and there is not a cure for hemangiosarcoma which can have a median survivial time 3-6 months, some cases are less and some are more. 4. Some patients have suffered blood loss and will require a transfusion. 5. Cancerous processes like hemagiosarcoma can spread to other organs, like the liver. There are some cases where this has occured, these masses are bleeding and we will recommend euthanasia while under anesthesia as these patients cannot survivie the blood loss. *

I have read and understand the risks.

NOCITA (bupivacaine liposome injectable suspension) is a long-acting, local anesthetic that provides up to 72 hours of post-operative pain relief by releasing bupivacaine (anesthetic pain relief agent) over time from multi-vesicular liposomes. Dr. Mair is happy to provide this additional form of pain medication during surgery for your patient if you would like to do so. Nocita is labeled For single-dose infiltration into the surgical site to provide local postoperative analgesia for cranial cruciate ligament surgery (TPLO, Extracapsular repair, etc) in dogs and as a nerve block in cats for declaw procedures. Like many drugs in the veterinary space that are used commonly but not specifically labeled for veterinary medical usage, we offer Nocita usage for pain control for our surgical patients off label to be used where deemed appropriate and safe. *

YES - I approve to have Nocita used at the time of surgery on my pet for pain control understand that in select instances it may be used off label when deemed safe by Dr. Mair. Please check with your regular veterinary clinic if it is already included in your estimate. If not included in your original estimate, generally a single dose of Nocita runs $200-$400.
NO - I do not approve Nocita pain control for my pet’s surgery.

I authorize Dr. Jacqueline Mair, DVM, DACVS-sa, MBA to perform surgery on my pet. Dr. Mair is a board certified small animal surgeon. *

I have read and authorize.

A cancellation fee equal to the surgery fee will charged if the procedure is cancelled less than 72 hours of scheduled surgery date. *

I have read and acknowledge the cancellation fee.

If anesthesia/sedation is required, I understand that there are risks involved and that in the event of an emergency, the hospital will take all necessary actions to control the problem and will notify me as soon as possible. I understand and agree to the use of human medicine in my animal when deemed appropriate by the Veterinarian. The estimated cost of these procedures is provided by Jacqueline J Mair DVM, DACVS, MBA I fully understand that this is an estimate only. Jacqueline J Mair DVM, DACVS, MBA makes every effort to remain within the estimate given. I agree to meet the costs of all treatment at the time of discharge. I understand the risks and complications of these procedures, which have been explained to me by the Veterinarian. All accounts are payable at the time of consultation unless a prior arrangement has been made. *

Signed by: *

Owner
Agent

CONTACT US TODAY!

We look forward to seeing you soon!

SCHEDULE AN APPOINTMENT



Email

[email protected]



Phone

Contact us

Have a Question?

Get in touch with our team! Complete the form below, and a member of our team will be in touch with you shortly.

Call Us:
Mon-Fri 8AM-5PM

Name *

First

Last

Email *

Phone

How can we help you? *

Name

© 2024 Mobile Surgery Services | Powered by WhiskerCloud