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The risk of these complications is reduced when you follow   •  You understand the known risks that accompany the procedure,
         postoperative instructions (including exercise restriction, preventing   and also understand that unforeseen complications may occur
         the pet from licking the surgical incision, etc.).     •  You understand that the procedure may not produce the results
                                                                  we hope to achieve
  VetBooks.ir  _________________________________________________________  •  You agree that you have been given time to ask questions regard-
         Other anticipated risks specific to your pet:___________________
                                                                •  You understand the alternatives to this procedure for your pet
                                                                  ing the procedure, that these have been answered satisfactorily,
                                                                  and that you are free to decline the procedure.

         ALTERNATIVES TO THE PROCEDURE
         Although there are no nonsurgical options for fixing a torn cruciate   ____________________________________  ______________
         ligament, it may be possible to provide your pet with a knee brace
         to help support  the injured limb as an alternative  to a surgical   Signature of pet owner/owner’s agent      Date
         procedure. Multiple types of braces have been developed to provide
         support to an injured knee to allow for pain relief. Because these   ____________________________________  ______________
         devices do not typically promote healing of the injured knee, they
         often need to be worn for life. Customized braces can be specifically   Witness to consent (signature)         Date
         fitted to your pet’s knee. If used under the close supervision of
         a veterinarian, pets can have a comfortable, active lifestyle while   ____________________________________
         wearing a brace.
            In addition to either having a surgical procedure performed or   Witness to consent (printed name)
         having your pet wear a knee brace, your veterinarian may recommend
         other lifestyle changes for your pet to improve their chances for a
         good outcome and good quality of life. These may include weight
         management, prescription of a specially formulated “joint friendly”
         diet, prescription of medications  to help with arthritis  and pain
         management, and physical therapy exercises.
            Without any intervention, your pet will develop arthritis in the
         unstable knee over time. This means that your pet will likely have
         chronic pain in that knee and may favor or use the leg less which
         can lead to loss of muscling in that limb.
         AUTHORIZATION
         By signing this form below, you agree that:
         •  You understand how/why the procedure is likely to help your
            pet
         •  You understand what will be done to your pet during the            Practice Stamp or Name & Address
            procedure

































         Also available in Spanish.


                     From Cohn and Côté: Clinical Veterinary Advisor, 4th edition. Copyright © 2020 by Elsevier Inc. All rights reserved.
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