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Central Kentucky Vet - Surgery Release Form 
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    AUTHORIZATION:

    I hereby authorize and direct the veterinarians and staff of Central Kentucky Veterinary Center to perform the procedures and additional diagnostic and /or treatment procedures as deemed advisable for {patientInfo[1]}. The natures or the procedure(s) has/have been explained to me and no guarantee has been made as to the results or cure. I understand that there are risks involved in these procedures. I agree to pay, in full, for services rendered, including those deemed necessary for medical or surgical complications or unforeseen circumstances. Any estimates or charges for the planned procedures are only approximations, and the final bill may be greater or less than these amounts. All Services Must Be Paid For When {patientInfo[1]} Is Released. Some Procedures Require A Deposit To Be Made Before Surgery. 

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    WAIVER:

    If {patientInfo[1]} is to be anesthetized, rest assured that advances in anesthesia and surgery have made routine procedures relatively safe with a low rate of complications. Nevertheless, occasional problems can arise due to pre-existing conditions not evident during routine pre-anesthetic examinations. To avoid these problems, we recommend the following. These will be performed (and you will be billed for them) unless you refuse them by checking. If {patientInfo[1]} is over the age of 7 years we require a Pre-Anesthetic panel before anesthesia. 

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    Included with procedure

    • IV Catheter and Fluids

    • Treatment for Pain by either Laser Therapy or Injection

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    ADDITIONAL SERVICES:  
    Please note any additional services that you would like us to perform while {patientInfo[1]} is anesthetized. 
                                    

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    Has {patientInfo[1]} had any food in the last 12 hours?              
    I fully understand and agree to the above procedures and terms.

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    Clear
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    Pick a Date
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    *Separate it with (,) Mark.
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