Equine Surgery Release Form

1

Your horse’s safety and comfort are our number one concern here at Red Oak Animal Hospital. Before your horse has surgery on * , it will be examined for any problems that could interfere with anesthesia and will be monitored after surgery to ensure that your horse has a safe, wonderful recovery. We are happy to report that our patients do very well and we expect it to go smoothly.

For our mature patients (over 15 years old) and for chronic health problems, we recommend more extensive pre-anesthetic blood testing. Occasionally we postpone surgery until a medical problem is resolved.

Even for our younger patients pre-anesthetic blood testing can help put your mind at ease. Certainly on rare occasions, problems are detected that change our plans.

Please let us know if you have questions about this testing. If you would like this testing done, please note below.

2

Today's Date* This field is required.

Date

3

Perform pre-anesthetic blood testing for my horse* This field is required.

Yes

No

4

Please specify* This field is required.

CBC/ Fibrinogen/ SAA (Serum Amyloid A)

CBC/ Fibrinogen/Equine Profile/ SAA (Serum Amyloid A)

5

When was your horse’s last tetanus (EWT)? * This field is required.If not up to date then we will booster today.

6

Pain management for my horse* This field is required.

Yes

No

7

Procedure(s)* This field is required.

8

Horse

Owner’s name

9

Signature of owner/ responsible agent* This field is required.I hereby authorize and direct Red Oak Animal Hospital P.A. to perform the procedure(s) noted above and to administer anesthetics or other drugs as deemed advisable for my horse. I understand the nature of the procedures and the relative risk involved. I authorize Red Oak Animal Hospital to provide any appropriate care should an unexpected complication arise.

Clear

10

Phone number where you can be reached* This field is required.

Please enter a valid phone number.

11

Email* This field is required.

example@example.com