Surgery Release Form

1

Your pet’s safety and comfort are our number one concern here at Red Oak Animal Hospital. Before your pet has surgery on * , it will be examined for any problems that could interfere with anesthesia and will be monitored after surgery to ensure that your pet has a safe recovery. We are happy to report that our patients do very well and we expect it to go smoothly.

Our younger patients’ pre-anesthetic blood testing will put your mind at ease and rule out any potential concerns. On rare occasions, problems are detected that change our plans.

For our mature patients (over 6 years old) and for any patients with chronic health concerns, we will perform a more extensive pre-anesthetic blood test. Occasionally we need to postpone surgery until a medical issue is resolved.

Please let us know if you have questions about this testing.

2

MICROCHIP IDENTIFICATION* This field is required.Prepare for disaster. Very few lost pets find their way home without permanent identification. Would you like us to implant a microchip while your pet is sedated?

Yes

No

3

PET’S NAME* This field is required.

4

PROCEDURE* This field is required.

5

OWNER’S NAME* This field is required.

6

SIGNATURE OF OWNER/RESPONSIBLE AGENT* This field is required.I hereby authorize and direct Red Oak Animal Hospital P.A. to perform the procedure(s) noted above and to administer anesthetics or other drugs as deemed advisable for my pet. I understand the nature of the procedures and the relative risks involved. I authorize Red Oak Animal Hospital to provide any appropriate care should an unexpected complication arise.

Clear

7

PHONE NUMBER WHERE YOU CAN BE REACHED* This field is required.

Please enter a valid phone number.

8

Email* This field is required.

example@example.com