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Anesthetic Consent Information Form

Our greatest concern is the well being of your pet. 

I am the owner/ agent responsible for the described animal. I have the authority and due hereby grant Lay Veterinary Endoscopy, Medical, & Surgical Svcs ( Lay Vet EMS ) my informed consent to receive, prescribe, and administer sedation, tranquilization, anesthesia, and to do diagnostics, treatments, surgeries, and pain management specifically related to the problem Layvet EMS has been asked to do. It has been explained to me that Dr. Lay is not board certified, but has training and experience beyond general practice and I have been encouraged to ask questions and have had my questions answered to my satisfaction. Lay Vet EMS suggest referral to a specialist, or otherwise more qualified veterinarian's capabilities , in any case where the care and treatment of the animal is beyond Lay Vet capabilities or appears to be in the animal's best interest. It has been explained to me that I am responsible for communicating with any other parties involved in the decisions made for my pet.  I understand that some risks always exist with these procedures and anesthesia , and I have been encouraged to discuss any concerns or questions with Lay Vet EMS and their veterinarian before the procedure(s) is/are initiated. I also understand that there may be unforeseen problems and issues , and that I understand Lay Vet EMS will keep me informed of these issues if they were to occur. I further understand that the anesthetic risks I am consenting to include, but are not limited to , any anesthetic complications up to and including death.  I have submitted my pets records, information,  radiographs, other images, all  laboratory results to Lay Vet Ems prior to sedation anesthesia and surgery.  

While Lay Vet EMS provides a high quality of anesthetic monitoring and services, there may be complications associated with any anesthetic procedure. I fully understand these risks and understand that Lay Vet EMS will try to minimize these risks. I agree not to hold Lay Vet EMS , the veterinarian, or any staff member liable for any complications that may arise. 

Surgical Information and Consent Form

Again being responsible for the described animal, I hereby authorize Lay Vet EMS to perform surgery and procedures for my pet. I acknowledge that no assurance or guaranty has been made of the results of surgery or treatment and the risks and probabilities of complications exist in any surgical or medical treatment, and I have expressed any concerns I have about them.

I further understand that Lay Vet EMS will make every effort to contact me after surgery, and that even though I may drop my pet off in the morning it does not necessarily mean that surgery will be performed in the morning. I also attest that I followed the pre-operative feeding and watering recommendations, and that any medications I have administered pre-operatively will be reported to Lay Vet EMS upon drop off.  For Lay Vet EMS to administer any of your pets medications the medicines must be in their prescribed container and written, signed directions for amount and time to give. Lastly I will inform Lay Vet EMS of any allergies or allergic reactions my pet may have or had,  and any changes in my pet since my last communication with Layvetems. I understand that I have been encouraged to ask any questions prior to procedures and my questions have been answered satisfactorially. 

This is information pertaining to surgical risks and probabilities. Lay Vet EMs places great focus and importance on being as sterile as possible with all aspects of a patients surgical care. With that being stated there is always a chance for surgical site infections. When these infections occur they can alter the results of surgery. It is important to follow all medicine recommendations,  post-surgical discharge instructions, and supervise the post-operative periods very closely. I understand that no quarantee of results of surgery or procedures has been made by Layvetems, and again any of my questions have been answered to my satisfaction.  By submitting this form with my signature and submitting my email I understand I am giving informed consent to any and all information provided.

 Lay Vet Ems always recommends and uses peri-operative antimicrobials.

The following information relates to the use of metallic and other implants and should be read and understood if your pet is going to have metatallic implants, or other corrective devices used in their treatment. 

The Use of Metallic Surgical Implants:

The use of metallic surgical implants is a means of bone fixation and helps generally in the management of fracture and reconstructive surgery. However these implant are intended to assist healing and are not intended to replace normal body structures.

Bone plate fixation devices are internal splints which align and fixate fractures, osteotomies, and other corrective procedures while normal healing occurs.

The sizes and shapes of bones and the numerous types of fractures and corrective procedures that occur in different aged, breeds, and size of patients , as well as the soft tissues surrounding and associated with bones and joints, place limitations on the size and strength of implants.

If there is a delayed union or nonunion of bone at a surgery site in the presence of weight bearing or load bearing , an implant could eventually fail or break . Therefore , it is very important that immobilization of the surgery site be maintained until firm bony union ( confirmed by clinical and radiographic examination) is established.

Factors such as the patients weight and size, activity level, and adherence to weight- bearing instructions have an effect on the stresses to which the implant is subjected to , and therefore on the life and success of the implant. It is important to know that bone fixation implants may break or fail at any time if they are subjected to sufficient stress.

Post- operative care is extremely important . Noncompliance to post- operative instructions could lead to loosening or breakage or failure of the implant requiring further surgery. There are specific warnings, precautions, and adverse effects that need to be explained and understood , and if you have any questions please inquire.

Additional information:

•Metallic internal fixation devices cannot withstand activity levels and/or loads equal to those placed on normal healthy bones. These devices are not designed to withstand unsupported stress of full weight-bearing. Internal fixation devices are load-sharing devices which hold a surgical correction site in alignment until healing occurs.

•It should be understood that stress on an implant can involve more than just weight-bearing. The weight of the limb alone, muscular forces associated with moving the limb, or repeated stresses of movement even of fairly small magnitude can result in failure of the implant.

•There are many other factors that interact in the healing process such as certain degenerative diseases or physiological conditions ( ie. Diabetes, heartworms, ) which may alter the healing process.

•Adverse effects and complications of internal fixation devices like bone plates, screws, pins, and wires include:

1.Infection is always a concern and possibility.

2.Non-union or delayed union of the surgical fixation.

3.Limb shortening or growth irregularities in young patients.

4.Decrease bone densitiy.

5.Pain,discomfort, or abnormal sensations due to the presence of a device.

6.Nerve damage due to trauma from the incident or surgical trauma.

7.Necrosis of bone , particularly as it applies to fractures with multiple pieces.

8.Vascular damage to blood vessels, lymphatics, and other soft tissues.

Post-operative care and the owners and patients willingness to follow instructions are two of the most important aspects of successful healing . It is very important to understand the limitations of implants and that physical activity and full weight-bearing too soon have been implicated in premature loosening, bending, or breakage of internal fixation devices.

Financial Policy and Payment information Policy

We are committed to your pet's treatment being successful and as cost effective for you as possible. The following is a statement of our Financial Policy. We ask that you read the information, and by signing the agreement you consent to this policy as well.

  • Full payment of fees will be due at the time service is rendered. 
  • Lay Vet EMS will accept cash, debit, VISA, Mastercard, Discovery, American Express, Care Credit, and Scratchpay. We do not accept checks. If you have any questions regarding fees or charges, please inform a member of our team before scheduling and  admitting your pet into our care. 
  • I understand that any estimates have been made in good faith, but that they are estimates and can be more or less once services are performed. 
  • Before any patient is scheduled or admitted into Lay Vet EMS care,  a deposit or card securing payment will be required and the balance due in full upon release. If you are interested more in one of our payment options ( Care Credit or Scratchpay ) and intend to use these services you will need to contact one of our team members prior to scheduling and inform them.
  • Since Lay Vet EMS is a mobile surgical team, we do surgery at several outstanding veterinary clinics, who will charge for their services in addition to Lay Vet EMS charges. Lay Vet EMS is a seperate entity and does not have any say in what they charge. Owner/agent/client will be responsible for paying Lay Vet EMS and the associated clinic at time services are rendered.

Clients Responsibility in Post- Surgical Patients 

The post-operative veterinary care of pets is different than in human medicine and surgery.  The owner must be informed and become a part of the health care team to maximize the results of any procedures or surgeries. 

This is an example of discharge informatation that will apply to your pet in some format. Please read and we encourage any questions. 

The owner must become a part of the team to care for him/her after their surgery to maximize the success of the surgery. It is of great importance that we all work to achieve the following recommendations for their good. The following recommendations will be placed in your hands and responsibility. As we work to achieve the healing of their surgery or procedures , our mission will be based upon this statement:

The effort and work we put in for "patient"  is only a temporary inconvenience intended to get a permanent change , the healing of the surgery/ies.

We will ask that you if you have the means to text or email us pictures and/or videos twice weekly for the first week then weekly for 3 weeks and then every other week afterward that you do so, that way we may help evaluate and monitor her progress. It will be your responsibility to provide this information and to contact us with any questions throughout the complete progress. If you do not have this ability ( usually a cell phone ) then let us know and we will make other arrangements to monitor "patient"


 We request communications through calls, text, and email, and ask that you stay in touch so that we can monitor their recovery.

Exercise Restrictions and Supervision:

This is an example of what you may be required to do post- surgically. Your instructions will be specifically related to the type of surgery that LayvetEMS performs. The owner will be responsible for being informed of what is expected of them and will do the recommendations.

"Patient"  should be either under your direct supervision or confined in a small area for the next few weeks. No free play. Avoid stairs , steps, and any surface that might cause slipping or falling. No running, jumping, playing, roughhousing , or getting too active. Below will be the outline we suggest for rehab/physical therapy.


 Regular Diet and free choice water after time designated. 

Prescriptions: "Patient"  has  medications recommended or previously provided by their primary care veterinarian. Please give them according to the directions from prescribing veterinarian and clinic. Any consultation of the medicines should be done prior to scheduling and any procedures, and by submitting this form I understand and have done this. 

Start the medications as directed at discharge time .

Incision Care: "Patient"  will have an incision related to the type of surgery LayvetEMS performs.. There may or may not be skin sutures to be removed . Please keep the incision clean, dry, and protected.

Observe the incision daily . There is some swelling and bruising associated with some incisions. 

Do not allow " patient"  to lick excessively or chew at the incision. If they do you will need to obtain an E collar ( cone ), doughnut, or protective sleeve to stop them.

By submitting this form to Layvetems I am giving informed consent to procedures and surgeries. I have been encouraged to ask questions and they have been answered to my satisfaction. Again I understand no guarantees have been made to outcome of such procedures or surgeries. 

Information, Agreements, and Consent


Email Address*

Date *

By Submitting my name and email address I state that I have read all above information, am giving informed consent to procedures and surgeries, have provided Layvetems with all information requested, and have been encouraged to ask any questions and my questions have been answered to my satisfaction.

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