Mt. McKinley AH - Surgical Release Form

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Consent for surgical care
Owner’s First Name
Owner’s Last Name
Pet’s Name
Today's weight
Email
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I, the undersigned, certify that I am the owner/agent of the animal described above. I give Mt. McKinley Animal Hospital permission to perform anesthesia and the following procedures:
Clear
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While there are risks associated with general anesthesia, be assured that Mt. McKinley Animal Hospital will take every precaution to minimize risk by always performing the following:

Physical exam prior to anesthesia

Multi-parameter monitoring (blood pressure, EKG, CO2, heart/respiratory/temp)

Intravenous (IV) catheter and fluid therapy

Preoperative and postoperative pain control injections

Endotracheal intubation and oxygen therapy

Injectable and inhalant anesthetics based on your pet’s age and specific medical needs
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Pre-Anesthetic Blood ScreeningBecause no surgery is without risk, it is advisable to perform a pre-anesthetic blood screen prior to surgery. Our veterinarians are recommending this procedure in order to help assess your pet’s basic organ function before undergoing anesthesia and surgery. If any abnormalities exist, we will contact you before proceeding or take steps to minimize the anesthesia risks. Please select an option below. *Blood work is strongly recommended for dogs and cats over 6 years old*
Yes, I want my pet to have pre-anesthetic blood screening.
No, I understand the risk of both the anesthesia and surgery and I DO NOT want a pre-anesthetic blood screen.
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MicrochipMicrochipping pets involves inserting a tiny rice-like microchip under your pet's skin. The chip then holds your pet's identity for life. If your pet is ever lost and a local shelter or veterinary practice finds it, the law requires that all pets be scanned for a microchip before they are adopted out or euthanized. The cost of a microchip is $58.50 which includes the first year of wellness and recovery benefits from HomeAgain and a lifetime of identification for your pet.
Yes, I would like to have my pet microchipped.
No, I do not want my pet microchipped.
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Phone Number(s): It is important that we have phone number where you can be reached if consultation is necessary while your pet is under anesthesia.
Phone #1
Phone #2
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I hereby authorize Mt. McKinley Animal Hospital to perform such diagnostic , therapeutic and surgical procedures as described above. The nature of such services has been described to me to my satisfaction. I realize that there are risks involved with any anesthetic or surgical procedure and that no guarantee or warranty can be made regarding the results or cure. I also authorize the hospital staff in an emergency situation, to follow through with such procedures as are necessary for the well being of my pet on a continuing basis until further communication with me I understand that veterinary care during the night time hours is provided at the discretion of the attending veterinarian. Continuous presence of personnel may not be provided during these hours. I have been given an estimate and understand that it is an approximation of planned procedures and the final bill may be more or less than this amount. I understand that I assume financial responsibility for all services rendered.
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Owner Signature* This field is required.
Clear
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Date* This field is required.
Date
Year
Month
Day
Should be Empty: