Surgery Treatment/Anesthesia Release Form

Surgery Treatment/Anesthesia Release Form

2. Laser Surgery Option

Laser surgery has many benefits including less post operative pain, less swelling and inflammation, less bleeding and faster healing.

Laser surgery prices Level I: $65 Level II: $85, Level III: $115, Level IV: $175

3. Blood Profile/CBC/Chemistry Panel

The use of anesthesia poses a potential health risk to your pet. To decrease the risks associated with anesthesia, a current pre-anesthetic blood profile (CBC/Chemistry Panel) is highly recommended. A blood profile can rule out any pre-existing conditions that may not be evident physically, but could lead to serious complications. This profile includes tests that check for anemia, infection, diabetes, kidney/liver failure, and other potential underlying problems.

Please note that the fees for this blood work are in addition to the cost of the scheduled procedure. Also, immature pets, aged pets, and sick/debilitated pets are in a higher risk group and may need more extensive blood work than what is offered on this release form. If your pet is in this higher risk group, please discuss blood work fees with the Doctor.

TO DECLINE the recommended blood work please initial below the following statement:
I understand that there is a potential risk of death associated with the use of anesthesia. I DECLINE the recommended blood work and request that you proceed with the authorized procedure.

4. Please list all phone numbers where you can be reached on the DAY OF SURGERY: