Anesthesia Release Form

  • I hereby authorize the following procedure(s) to be performed by the admitting veterinarian, or designated associates and assistants:
  • There are risks associated with any anesthetic procedure. To help minimize the risk, a pre-anesthetic blood screen will be performed on all patients undergoing anesthesia, unless otherwise indicated by your veterinarian. Selected laboratory tests can help to assess your pet's ability to metabolize and eliminate the anesthetics we administer. In addition, the results may reveal hidden health conditions that could put your pet at risk while under anesthesia. Our mobile clinic laboratory is fully-equipped to perform these blood tests and have the results available prior to anesthesia.

    NOTE: Intravenous (IV) catheters will be placed in all patients undergoing anesthesia. Placement of an IV catheter allows delivery of fluids to assist in maintenance of your pet's blood pressure, hydration and to assist their organs in metabolizing the anesthetic drugs more efficiently. Additionally, in the events an emergency situation develops, an IV catheter allows rapid access for drug administration. (A small area of hair may be clipped for IV catheter placement)

  • If problems unrelated to the authorized anesthetic procedure are found that require ELECTIVE correction, I may be reached at the following phone number(s)
  • I understand the above anesthetic and surgical, diagnostic or therapeutic procedures may involve risk of complications, injury or even death, from both known and unknown causes and no warranty or guarantee has been either expressed or implied as to result or cure. Furthermore, I authorize the clinic staff in an emergency situation, to follow through with such procedures as are necessary for the well being of my pet on a continuing basis until further communication with me. I agree to assume financial responsibility for all routine and emergency services rendered.

    Your signature below constitutes your acknowledgement, as the owner or owner's agent, that (i) you have read and agreed to the above, (ii) the procedure(s) have been explained to your satisfaction and that you have all the information that you desire, (iii) you have had the chance to ask questions, and (iv) you authorize and consent to the performance of the procedure(s) and to the administration of anesthesia.