Oklahoma Veterinary , LLC Dr. Zachary H. Ricker, DVM, MS, DACVS-SA Dr. Jennifer Schultz, DVM, DACVS-SA Dr. Jason Duell, DVM, DACVS-SA Dr. Jonathan Pucket, DACVO Phone: (918) 299-4900

INFORMED CONSENT

Please review the following consent. If you have any questions, please direct them to the examining your animal. Beth Sims Malachi Sims 14751 S Urbana Ave, 76203 Bixby, OK Male, 74008 Rottweiler, 3 Yrs. 8 Mos.

Best Contact Number: ______Estimated Cost of Treatment: $_2800.00-3200.00_ Initials: ______Surgery Deposit Required for Treatment: $_2500.00_ ER/Afterhours Practice Deposit : $_250.00_

Surgical estimates do not include follow-up radiographs, bandage changes or medications that may be necessary at post-operative visits.

Your will require sedated x-rays in the future to monitor the healing process. This is estimated to cost 290-325.00 per recheck.

Remaining balance due at patient discharge from Oklahoma Veterinary Specialists, LLC / Oklahoma Veterinary Surgery, LLC.

1. I am the owner or agent for the owner of the above described animal. I am mentally competent, under no duress or the influence of drugs or alcohol, and am over the age of eighteen.

2. I consent to and authorize the performance of general and/or of my animal: Yes No (Please check preferred response).

3. In the event of cardiac arrest, I desire resuscitation measures to be performed on my animal. Yes No (Please check preferred response).

4. In addition to the above procedures, I authorize the following: _General anesthesia, Unilateral TECA-LBO surgery, pain management, drain placement, 24-48h hospitalization bulla culture.

5. I understand that during the performance of procedure(s) or operation(s), unforeseen conditions may arise that necessitate an extension of the above procedure(s) or operation(s) or different procedure(s) or operation(s) other than those set forth above. Therefore, I hereby consent to and authorize the performance of such procedure(s) or operation(s) as necessary and desirable in the exercise of the veterinarian’s professional judgment. Yes No (Please check preferred response). 6. I have been advised as to the nature of the procedure(s) or operation(s), feasible alternatives, and the complications involved. I understand results cannot be guaranteed. I understand complications are inherent to some degree in any medical procedure and/or operation. I understand not all complications can be predicted. I understand that complications may result in prolonged hospitalization and may require additional diagnostic tests, treatment, procedures, and/or operations. I understand the costs associated with any complication, including additional diagnostics, treatment, procedures, and surgery that may arise from or during the diagnosis and treatment of my animal at Oklahoma Veterinary Surgery, LLC / Oklahoma Veterinary Specialists, LLC are my responsibility.

Risks or complications associated with the above described procedure(s) and/or operation(s) include, but are not limited to: -- Anesthetic Events -- Failure to Heal / Improve -- Facial nerve paralysis -- Dehiscence -- Worsening of Condition -- ______-- -- Seizures -- ______-- Bleeding -- Death -- ______-- Aspiration -- Neurologic Injury -- ______-- Implant Failure -- Other:_Draining tract (infection) -- ______

7. I understand it is my responsibility to return for this animal when treatment is completed. Three days after being informed of such, if the animal has not been discharged, it will be considered abandoned and becomes property of the Oklahoma Veterinary Surgery, LLC. Such action does not relieve my obligation for paying all incurred charges.

8. Should I request, or it become necessary, to handle my own animal, I waive the option of legal action against Oklahoma Veterinary Surgery, LLC / Oklahoma Veterinary Specialists, LLC its employees, agents, and governing entities, in the event I am injured.

9. I understand that to ensure proper continuity of care Oklahoma Veterinary Specialists LLC / Oklahoma Veterinary Surgery, LLC will contact your normal (referring) veterinarian to provide and obtain any pertinent information regarding your pets health. We also request that you continue follow-up care with your pets normal (referring) veterinarian at the conclusion of treatment at Oklahoma Veterinary Specialists, LLC / Oklahoma Veterinary Surgery, LLC. Therefore, I hereby consent to and authorize the performance of such communication(s) and affirm my commitment to returning to the referring veterinarian at the conclusion of treatment. Yes No (Please check preferred response).

10. I understand that Oklahoma Veterinary Specialists & Emergency, LLC and Oklahoma Veterinary Surgery, LLC are separate practices therefore this may require separate transactions upon the completion of treatment. Furthermore, I understand that my pet will incur charges with Oklahoma Veterinary Specialists & Emergency if hospitalized overnight, through the weekend, on holidays, or any other time the surgery practice is closed. Yes No (Please check preferred response).

I HAVE READ AND UNDERSTAND THIS CONSENT AND VOLUNTARILY EXECUTE MY AUTHORIZATION.

Owner / Agent Signature:______Date: 12/11/2019 Staff Initials:______About Us / Frequently Asked Questions

What are your hours?

The surgery practice office hours are M-Fr from 8:00am to 4:00pm. This can vary on occasion due to case load. Surgery consultations and recheck visits are scheduled M-F between 8:30am and 11:00am. Our doctors are in the OR otherwise.

Ophthalmology office hours are M-Th from 8:00am-5:00pm. Consultations are scheduled between 8:30am and 4:00pm

Our surgeons and ophthalmologist are available afterhours for emergency patients assessed via our ER department doctors.

The Oklahoma Veterinary Specialists ER practice is open 24 hours a day every day of the year.

What time will my pet have surgery?

Patients are operated utilizing a triage system therefore definitive or absolute times for a procedure are not given. The most critical or delicate patients take priority over more stable patients. As a regional veterinary critical care and trauma center we never know what a day may bring in terms of case load. Admission of trauma patients or other patients with more severe problems can delay the operation of a more stable patient to later in the day without advanced warning.

Will I receive post operative instructions?

Written discharge instructions will be provided for most major procedures. Please be sure to give our receptionists an accurate email address as our doctors may email the discharges to you for review prior to picking your pet up from our facility. Our veterinary surgery nurses will review this document with you at the time of discharge if before 4:00pm. After hour / holiday / weekend / etc. discharges will be performed by one of our talented ER nurses or receptionists. The ER nurses may direct you to contact the surgery service during normal hours if you have specific questions regarding the discharges. Lab results that become available after discharge from the hospital will be shared via email and/or telephone conversation. Please make sure your telephone numbers and email address are correct in our system.

Who takes care of my pet afterhours?

Seamless overnight care is integral to patient recovery therefore our location is also home to a 24-hour emergency veterinary service and internal medicine practice. The ER service is a separate company and their experienced doctors and staff monitor our hospitalized patients overnight. These doctors have direct access to the specialists in charge of your pets care. You will pay a separate bill for any overnight / weekend / holiday / etc. care they provide.

Are post-operative visits included in the price for surgery?

Suture removal is complementary, but any additional follow-up for bandage changes, sedation, x-rays, medications, etc. is not included in the cost for a procedure. Veterinary patients vary greatly in size and can heal at differing rates. Our treatment and recheck recommendations are tailored to the needs of the individual pet therefore it is impossible to accurately estimate everything a patient may need during the course of their recovery.

What is a veterinary specialist?

"Veterinary specialists are who have advanced training in various veterinary medical and surgical disciplines and are board certified. To become board certified, a veterinarian must have completed, at a minimum, four years of veterinary college, a one year internship or equivalent, and two to three years in a residency program that meets the standards of a recognized specialty college or board. There are additional training and caseload requirements that must be met during the residency and finally, the veterinarian must pass a series of rigorous examinations.

Not all veterinarians that call themselves “specialists” have completed this training. Veterinarians that have passed these examinations and completed all requirements become Diplomates of their respective specialty colleges. This Diplomate status indicates recognition of the board-certified specialty by the American Veterinary Medical Association’s (AVMA) American Board of ." Check out www.vetspecialists.com for more info!

Are your surgeons and ophthalmologist board certified specialists?

Yes! All of our surgeons are Diplomates of the American College of Veterinary Surgeons. Our ophthalmologist is a Diplomate of the American College of Veterinary Ophthalmologists. To learn more about their rigorous training programs visit: www.acvs.org and www.acvo.org. Our hospital is also home to specialists in internal medicine (www.acvim.org) and Dr. Foust is in the final stage of obtaining her certification in dermatology (www.acvd.org).