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Authorization for Anesthesia and/or Surgery
Authorization for Anesthesia and/or Surgery
*
Indicates required field
Owner's Name
*
First
Last
Patient's Name
*
First
Last
Phone number you can be reached at today:
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Would you like to receive text message updates and pictures of your pet after his/her procedure?
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Yes
No
Call Only
Anesthetic and surgical procedures(s) to be performed:
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Spay
Neuter
Dental
Mass Removal
Other
If selected other please describe
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I, the undersigned, certify that I am the owner, or authorized agent of the owner, of the animal described above. I also understand that during the performance of the procedure(s), unforeseen conditions may arise that the necessitate a modification in the procedure(s) set forth above. I, therefore, consent to the performance of such procedure(s) deemed necessary by the veterinarian. I understand the procedure being performed involves the use of a sedative or anesthetic and that there is a slight risk involved. I also acknowledge that there are no guarantees, either expressed or implied, that the procedure(s) will be without complications. I am aware that these unforeseen events will not relieve me from my obligation to all costs incurred during the treatment of the animal. I give McKay's Mill Animal Hospital full and complete authority to perform the procedure(s) indicated. I am aware that my pet must be current on required vaccinations and must be free of external parasites. Vaccinations and/or parasite control will be given if necessary and I will be responsible for the charges. I have read and understand the information above
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Yes
No
Laboratory Testing
Advances in anesthesia and surgery have made routine procedures relatively safe with a low rate of complications. Nevertheless, occasional problems can arise due to pre-existing conditions not evident during routine pre-anesthetic examinations. To help avoid these problems, we perform pre-anesthetic blood screening. Pre-anesthetic blood screens are recommended for all pets, but for pets over the age of 6 these tests are required. Geriatric pets benefit from more comprehensive bloodwork prior to anesthesia.
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Pre-Surgical Blood Screen (Chem10, Lytes, CBC) $69.95
Geriatric Pre-Surgical Blood Screen (Chem17, Lytes, CBC) $139.
Decline
Microchip Authorization
Microchipping is a safe, simple and permanent form of pet identification designed to quickly identify lost pets and reunite you with your pet. The microchip can be implanted during your pet's scheduled procedure.
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Yes, please microchip my pet today ($59.00)
My pet is already microchipped
Decline
Email Address for microchip registration
*
Submit
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Authorization for Anesthesia and/or Surgery
