Merrill Animal Clinic - Anesthesia Release

Date

Pet's Name

Owner's Name

I am the owner or authorized agent for the animal described above and I have the authority to execute this consent. My signature below certifies that I am over eighteen years of age.

Although rare, sometimes an underlying or previously undiagnosed medical conditions can cause complications when a pet is under anesthesia. I further understand that during the course of the operations or procedures, unforeseen conditions may arise that necessitate the performance of additional procedures deemed necessary for the veterinarian. I understand the risks of anesthesia and surgery and authorize the doctors and staff of Merrill Animal Clinic to perform these procedures. I authorize the use of appropriate anesthesia and pain relief medications as needed before, during and/or after the procedure.

I am encouraged to discuss any concerns I have about the risks with the attending veterinarian before the procedure is initiated. The nature of the operations or procedures have been explained to me and I understand what will be done. I am aware that the practice of veterinary medicine is not an exact science and, thus, there are no guarantees for successful treatment. I accept that my financial obligations remain regardless of the outcome. I am aware that my pet must be flea-free. If fleas are found on my pet, I authorize an appropriate flea treatment to be administered. I understand that my pet must be current on rabies vaccines as well as all core vaccines (CANINE: DHPPV, BORDETELLA) (FELINE: FVRCP)

To reduce the risk of complications during anesthesia, we recommend presurgical blood work.

Please initial if you would like your pet to have presurgical blood work before today's procedure

We strongly encourage microchipping at the time of anesthesia. Our microchipping service includes inserting the microchip and registering it with HomeAgain Microchip company.

If you would like your pet microchipped today, please initial here

For dogs and indoor cats only: Yes, I would like my pet's nails to be trimmed after surgery

CPR: In the event that Jitterbug should experience cardiac or respiratory arrest while being hospitalized today, you may consent for resuscitative efforts to be initiated until you can be contacted further and notified of Jitterbug status. By consenting to this service, you are also acknowledging that certain fees will apply. If you are not able to be contacted immediately, resuscitation efforts will be continued to be performed at the doctor's discretion. Please initial you choice below:(Required)

I agree to CPR being performed in case of arrest

I elect a "DO NOT resuscitate" status in case of an arrest

I have read and understand this authorization and hereby accept and agree to the terms of the consent form.

Client Signature