Anesthesia Surgical Release Form

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Anesthesia Surgical Release Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Please Read Carefully

I, the undersigned, certify that I am the owner, or authorized agent for the owner, of the animal(s) listed above. I authorize the veterinarian(s) and staff of West Side Animal Clinic to perform the procedures listed above and/or on the estimate for my animal. I also authorize the administration of pain-relieving, sedating, and anesthetizing medications as well as the necessary and appropriate medical, surgical, diagnostic, nursing, and emergency treatments for my animal. I have been advised of and understand the need for and potential risks of these procedures, and I acknowledge that no guarantees of treatment are made.

West Side Animal Clinic offers the safest anesthetic and surgical procedures available for your pet. However, there is always an element of risk with any anesthetic procedure, and occasionally, problems may occur during or after medical and surgical procedures. For example, your pet may experience mild nausea, adverse drug reactions, or prolonged recovery due to organ problems. In rare instances, death may occur.

West Side Animal Clinic uses “Isoflurane" as the general anesthesia agent for your pet. This provides superior anesthetic safety as well as a smooth induction and recovery process. We also require that all pets have blood tests and/or other screening tests prior to us administering anesthesia. These tests help identify underlying problems that may increase risks to your pet during anesthesia and in the future.

Be advised that if your pet will be staying the night at West Side Animal Clinic, there is no overnight supervision by our staff between the hours of 7:00pm and 7:30am.

By initialing here, I understand that there is a possibility that misfortune may happen to my pet during the hours of no supervision, and I will not hold West Side Animal Clinic responsible for any misfortune that may happen to my pet.

I have read and understand this form, and I accept responsibility for payment of all charges incurred and services provided to my animal by West Side Animal Clinic.

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