Surgery Authorization Form

I, First Name* Last Name* do hereby give permission to Susan Gaffney, DVM or Rachel Valentine, DVM of Angel Fire Small Animal Hospital to anesthetize my pet, Pet's Name*, to perform a * on Date* .

Other:

**PRE-ANESTHETIC BLOODWORK: To ensure your pet can properly process and eliminate an anesthetic, we recommend performing bloodwork on all pets undergoing anesthesia. The type of bloodwork varies with the age of your pet. There is an additional cost for this blood screening.

I agree to the pre-anesthetic blood screening.*

YesNo

Blood Screening Options:

Juvenile Profile (Under 4 years of age): $40.00Adult Profile (Dogs 4-10 yrs - Cats 4-14 yrs): $60.00Geriatric Profile (Dogs 10+ or 8+ if over 80lbs - Cats 14+): $95:00

**GERIATRIC PATIENTS: Geriatric dogs (10+ or 8+ for dogs over 80lbs) and cats (14+) may have an intravenous catheter placed to allow immediate access to a vein in case of an emergency or to give fluids during their procedure. It is necessary to shave the hair on one of more front legs for this procedure.

I agree to an IV catheter being placed in my pet if medically necessary.*

YesNoCall me to discuss firstNot Applicable

**DENTAL PROCEDURES: If your pet is here for a teeth cleaning and it is medically necessary for the health of your pet for teeth to be extracted, there will be an additional charge for extractions.

I agree to any extractions being pulled as medically necessary.*

YesNoCall me to discuss firstNot Applicable

*

**All patients will receive pain medication when needed.