Anesthesia Release

Animal's Choice Veterinary Clinic, LLC Surgery/Anesthesia Release Form

Owner's Name*

Address*

Phone number I can be reached today about my pet's surgery*

Patient*

Reason for Admittance*

I hereby authorize and direct Brad Nunley, DVM and staff to perform the procedures and additional diagnostic and/or treatment procedures as deemed advisable for my pet. The nature of 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 may be risks involved in some of 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 In Full When The Animal Is Released. Some Procedures Require A Deposit Before Surgery.

Pre-Anesthetic Blood Testing The use of anesthesia poses a potential health risk to your pet. To decrease the risk associated with anesthesia, we highly recommend that pre-anesthestic blood profile be performed prior to the administration of anesthesia. The blood profile can rule out any pre-existing conditions that may not be physically evident, but could lead to serious complications. These tests help us detect anemia, dehydration, kidney disease, and liver disease. The cost for pre-anesthetic blood work is $85.

Please select one of the following:

Yes, I would like my pet to have the blood work as an added method of safety. The cost is $85.No, I understand the recommendation, but I decline the blood work

We recommend pain medication for all surgeries.

Please select one of the following:

Yes, I would like pain medication, which includes a pain injection and take home pain medication. The cost is $30.No, I understand the recommendation, but I decline any pain medication.

Laser Treatment

We are pleased to offer laser treatment for the surgery incision. Laser treatments helps speed up healing at the surgery site, reduces inflammation, and reduces the formation of scar tissue.

Please select one of the following:*

Yes, I WOULD LIKE laser treatment on the surgery site. The cost is $15.No, I would NOT like the laser treatment.

In order to keep the clinic flea and tick free, we will treat any pet that has fleas or ticks with the appropriate medication at owner's cost.

I understand and agree to the above terms. I understand that all anesthesia involves some risk to my pet, but Brad Nunley, DVM or any staff will not be held liable or responsible in any matter whatsoever, or under any circumstances in connections therewith.

Signature*