Surgery Waiver


Please complete this form before your next visit.

I have also been informed that there are certain risks and complications, including death, associated with any operation or procedure of this type. I further understand that during the course of the operations or procedures, unforeseen conditions may arise that may necessitate the performance of additional procedures.


Blood Work


Basic anesthesia charges include an initial physical exam, pre-anesthetic assessment of anemia or kidney disease, and monitoring of cardiac function during anesthesia. I understand that underlying disease may increase anesthetic risk, especially in animals over five years of age or in ill animals. The doctor’s choice of anesthetic medications may be altered accordingly if pre-existing problems are known. Pre-anesthetic blood work will be run in order to determine if surgery will be performed to help to alert the doctor to these conditions. As the responsible owner/party, I understand these conditions.



We offer identification microchips, which can be injected while your pet is under anesthesia. The benefit of having your pet chipped is permanent identification for the life of your pet. Your pet will have a one-of-a-kind number that is specific to only to them.

I am the owner or the agent for the owner for the animal described above, and I have the authority to execute this consent.