Surgery Release Form 

NEEDED FOR ANY ANESTHETIC PROCEDURE

IV CATHETER AND INTRA-OPERATIVE FLUID ADMINISTRATION ARE REQUIRED FOR GENERAL ANESTHESIA.

Owner *
Owner
Number *
Number
Address *
Address
PREANESTHETIC BLOOD TESTING *
Like you, our greatest concern is the well-being of your pet. Before putting your pet under anesthesia, we will perform a full physical exam. However, many conditions, including disorders of the liver, kidneys, or blood are not detected unless blood testing is performed. For these reasons, we HIGHLY suggest blood screening BEFORE anesthetic procedures. Please state if you would like your pet to receive the pre-operative blood work.
DENTAL PATIENTS ONLY *
I authorize dental extraction(s) during dental cleanings in the event the veterinarian deems necessary for the health of your pet. Please state if you authorize authorize necessary extraction(s.) Price depends on tooth and severity.
Please Indicate If Your Pet Requires Additional Services *
I, being responsible for , have the authority to grant The Uptown Veterinary Hospital my consent to receive, transport, prescribe for, treat, and/or operate upon. I understand that during the performance of the foregoing procedure(s) or operation(s), unforeseen conditions may be revealed that necessitate an extension of the foregoing procedure(s) or operation(s) or different procedure(s) or operation(s) than those set forth. Therefore, I hereby consent to and authorize the performance of such procedure(s) or operation(s) as are deemed necessary and desirable in the exercise of the veterinarian’s professional judgment. I also authorize the use of appropriate anesthetics and other medications used by the veterinarian. I understand that hospital support staff will be employed as deemed necessary by the veterinarian. I have been advised of the nature of the procedure(s) and/or operation(s) and of the risks involved. I understand that the results cannot be guaranteed. Payment is required in full when pet(s) is released/discharged from the hospital. I have read the above, understand and agree to this authorization and consent form. If you agree to the terms above please provide your name & date.
Phone number where you can be reach today *
Phone number where you can be reach today
 

For more information:

504.897.4973 (phone)

504.897.4938 (fax)