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Surgical Release Form
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Name
This field is for validation purposes and should be left unchanged.
To make your pet’s anesthetic procedure as safe as possible, our doctors would like you to read the following information.
Before putting your pet under anesthesia, our doctors perform a full physical exam. However, many conditions cannot be detected unless blood testing is performed. These tests look for infections, anemia, cardiac disease, and kidney/liver disease. If any abnormalities are noted, surgical procedures may be postponed or the type of anesthetic adjusted. All pets, regardless of age, are benefited by this testing.
Please check the appropriate box and sign where indicated.
Preoperative Bloodwork
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<8 Years: CBC, Chemistry 10, Electrolytes $135.95
8+ Years: CBC, Chemistry 10, Electrolytes, SDMA, Urinalysis $193.41
Decline
Microchip: A permanent microchip can be placed to help identify your pet if lost.
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Yes, please place a microchip ($42.00)
No, do not place a microchip
ECG (Electrocardiogram): This electronic tracing of the heart beat can help identify arrhythmias or heart enlargements prior to anesthesia.
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Yes, please perform an ECG ($52.50)
No, do not perform an ECG
Therapeutic Laser Treatment: This rapidly increases healing time and reduces pain levels.
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Yes, please perform laser therapy treatment ($15)
No, do not perform laser therapy.
It is important to understand that a pre-anesthetic profile DOES NOT GUARANTEE the absence of anesthetic complications. It may, however, greatly reduce the risk of complications as well as identify medical conditions that could require treatment in the future.
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If my pet it undergoing a dental cleaning today and the doctor determines that one or more teeth need to be extracted, I understand that this is an additional charge.
If my pet is undergoing a spay today and is pregnant or in heat, I understand that this is an additional charge.
Pets Name
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Signature
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I consent to signing this document electronically.
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I consent to signing this document electronically.
Date
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Pet Education
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Contact
Memorial Wall
Home
Services
Veterinary Services
Boarding
Bathing & Grooming
End Of Life Care
Daycare
Spay & Neuter
Preventive Care Plans
Dog Training
About
Meet our Team
Pet Education
Forms
New Client/Patient
Boarding Request
Employee Application
Shadow/Volunteer
Surgical Release
Contact
Memorial Wall
Home
Services
Veterinary Services
Boarding
Bathing & Grooming
End Of Life Care
Daycare
Spay & Neuter
Preventive Care Plans
Dog Training
About
Meet our Team
Pet Education
Forms
New Client/Patient
Boarding Request
Employee Application
Shadow/Volunteer
Surgical Release
Contact
Memorial Wall
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