Surgical Release Form

Surgical Release
Name
Name
First
Last
I hereby consent and authorize you as the doctor and staff of Sahara Pines Animal Hospital to receive, prescribe for, treat and operate upon my pet
I, the owner or agent for the above pet, realize that no guarantee or warranty can professionally or ethically be made regarding results or cure. I understand that with the use of any anesthetic agent, an element of risk is involved and will NOT hold Sahara Pines Animal Hospital or its agents responsible or liable under any circumstances. I further request and authorize the doctors of Sahara Pines Animal Hospital to do what they deem advisable or necessary should any unforeseen conditions arise. Possible alternative methods of treatment, risks involved and possible complications have been fully explained and understood by me.

Surgical Procedures Include (check each to acknowledge)

IV CATHETER & FLUIDS
IV FLUIDS help support the heart and blood pressure during any anesthetic procedure. In an emergency, the IV CATHETER also provides rapid intravenous access to support the body with medications.
COMFORT MANAGEMENT PACKAGE
As a smooth and comfortable recovery helps to ensure better healing, a Pain Relief Injection preceding surgery will be performed. A Pain Management Medication will also be prescribed and sent home with your pet
Bitter Spray or Medical Collar (please choose one)
By providing one of these, we can help decrease post-operative complications from licking or chewing at surgical incisions.

Available Blood Tests

At Sahara Pines Animal Hospital we are constantly striving to provide your pet with the very best care utilizing the latest in medical technology. While every animal receives a full physical examination before anesthesia, there are certain conditions of the liver, kidneys and blood that cannot be detected unless BLOOD TESTING is performed. These tests are performed safely and accurately in-house before induction of anesthesia.
Pre-operative Panel (selected chemistries + PCV)
Additional Cost: $114.70
Require for any pet undergoing anesthesia.
Full Blood Panel (full chemistries + CBC)
Additional Cost: $204.63
Mandatory for any pet over 7 years.

EKG Screening

An EKG screening can help detect underlying HEART DISEASE that cannot be detected during a routine physical examination.
Additional Cost: $98.01
Highly recommended for any pet, especially for those over 7 years of age. (May be required in certain cases where there is suspected or known cardiac disease.)

Additional Recommended Options

Fluoride Treatment
Additional Cost: $12.46
Fluoride is important in producing HEALTHY STRONG TEETH. While most important in young growing animals, all pets can benefit from this treatment. Fluoride is available for all pets undergoing anesthesia with tarter free teeth. Strongly recommended after dental cleanings!
Save This Life/Google Microchip Implant & Registration
Additional Cost: $76.98
While your pet is under anesthesia a permanent microchip can be injected under the skin. If your pet should become lost or even stolen, the microchip provides a MEANS OF IDENTIFICATION and also aids in finding your animal.
Hip Dysplasia Screening
Additional Cost: $117.30
Most suited for medium to large breed dogs 6 months to 2 years of age. X-rays are taken of the hips to detect early changes that may indicate future problems with ARTHRITIS AND HIP DYSPLASIA. Ask our doctors for more information about this important condition.

Authorization and Release

I hereby authorize the doctors and staff of Sahara Pines Animal Hospital to perform the surgical procedures as outlined above. I assume full responsibility for the payments due when services are rendered.