Surgery Release Form

Our concern is for the safety, health and comfort of your pet. It is important that we assess the-complete health status of your pet before undergoing anesthesia and surgical procedures. We will perform a physical exam and we strongly recommend a blood profile for all patients. This test is similar to the tests that your own physician would run if you were to undergo anesthesia. This bloqd profile helps alert us to ttie presence of dehydration, anemia, infection, diabetes and/or kidney or liver disease that could complicate the procedure. For patients over 8 years of age a blood profile is required unless already completed in the past 30 days. IV fluids are also required for animals 8 years or old. We also recommend a test to detect blood clotting disorders for major surgeries.

Pet History

Please provide the following information:

As the owner of the pet described above I hereby give Bonner Springs Animal Care Center, its Doctors and staff consent and authority to provide the above described procedure. I understand the procedure as it has been explained to me. I have been informed that there are certain risks and potential complications and those conditions may arise that require c~anges in the treatment procedure. I authorize the use of the appropriate medical treatment including anesthetics and analgesics before, and after the procedure.