Anesthetic & Pre-Surgical Release Form

Pre-Surgical Bloodwork:

In order to recognize any underlying abnormalities your pet may have, and to determine any increase in anesthetic risk, we recommend a pre-surgical blood profile be completed. This complete blood cell count (CBC) and chemistry panel will check for signs of infection/inflammation, anemia, platelet counts, blood glucose, kidney function and liver function. Electrolytes are also screened to check for imbalances that can cause heart arrythmias, prolonged healing and other health issues. Testing can significantly reduce the medical risks associated with anesthesia. A healthy-appearing pet may be hiding symptoms of disease (a patient can lose up to 75% of kidney function before showing any visible signs of illness). These tests provide baseline levels for your pet and become part of his/her medical record for future reference.

• For pets UNDER 7 years of age, bloodwork is optional.
• For pets OVER 7 years of age, bloodwork is required

All surgeries include an IV catheter, fluid therapy, and full anesthetic monitoring throughout the procedure

– Spays and neuters include post-operative pain medication. All other procedures will have pain medication added on as a separate fee as indicated. Please see treatment plan for these costs.

While your pet is in the clinic, would you like any of the following performed:

Authorization to Perform surgery and/or treatment

I understand that the administration of anesthesia involves some risk to my pet, including rare reactions to medications & possible death. I consent to the use of medications as deemed necessary by the veterinarian. I understand that all procedures & surgery also involve some risk to my pet. The most common risks include, but are not limited to, bleeding, nerve damage, & infection. I also understand that no guarantees or assurances have been made regarding the outcome of this procedure. I understand that the doctors and staff at Key City Veterinary Clinic will use reasonable precautions against injury, escape, complications, & death. While I accept that all procedures will be done to the best of the abilities of the staff at Key City Veterinary Clinic, I understand that no guarantee or warranty has been made regarding the results that may be achieved. Key City Veterinary Clinic will also make every effort to contact me prior to determining or performing any additional treatment that changes the original estimates, outside of emergency care which will be deemed necessary by the veterinarian. I understand that Key City Veterinary Clinic will make every reasonable effort to contact me prior to performing additional procedures & that if I cannot be reached an additional anesthetic procedure may be required in the future to avoid keeping my pet under anesthesia longer than necessary. I understand there is not an emergency fire sprinkler system and that animals are not monitored overnight.