Canine Spay Neuter Release Form

Owner

Pets Name

Date

• ANIND: Anesthesia Induction

• ANIND: Anesthesia Induction

• ANINH: Anesthesia Inhalation

• ANINH: Anesthesia Inhalation

• HOSSX: Hospitalization Post-Operative

• HOSSX: Hospitalization Post-Operative

• PNMGT: Pain Management

• PNMGT: Pain Management

• PolySX: Antibiotic Injection

• PolySX: Antibiotic Injection

• VITMON: Monitoring of Vital Signs

• VITMON: Monitoring of Vital Signs

• POPNMG: Post-Operative Pain Management

• POPNMG: Post-Operative Pain Management

• IVCSX: IV Catheter

• IVCSX: IV Catheter

• IDPRSX: Idexx Pre-Surgical Panel Includes CBC-CHEM10

• IDPRSX: Idexx Pre-Surgical Panel Includes CBC-CHEM10

The above pricing is for the UNCOMPLICATED procedures. In the event we experience a surgical complication such as your pet being in HEAT, PREGNANT, HAVING a PYOMETRA (infected uterus), being a UNILATERAL or BILATERAL CRYPTORCHID or being OBESE (BCS>or = to7/9). ADDITIONAL CHARGES MAY BE APPLIED.

Pre-Anesthetic blood work is for the safety and well-being of your pet. Bloodwork is required for any procedure that calls for the patient to be sedated.

I, hereby authorize the indicated procedures to be performed by the admitting veterinarian, or designated veterinary associates(s), and/or veterinary assistants.

I understand the above anesthetic, diagnostic and surgical procedures may involve risk of complications, injury or even death, from both known and unknown causes. No warranty or guarantee has been expressed or implied as to result or cure.

Furthermore, I authorize the hospital 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, elective, and emergency services rendered.

Signature

Emergency Contact #

Date