Authorization for Anesthesia-Surgical Treatment Our greatest concern is the well being of your pet. We will perform an examination on your pet prior to giving anesthesia. Many conditions, including disorders of the liver, kidneys, or blood are not detected unless blood testing is performed. These metabolic derangements could lead to complications or even deathInitialsTo avoid potential problems, and further protect your pet’s health and safety, we strongly recommend blood screening prior to any anesthetic procedure. Our in‐house laboratory is fully equipped to perform these tests. Results will be available and evaluated before anesthesia is given to your pet. YES, I APPROVE FOR MY PET TO HAVE THE PRE‐ANESTHETIC BLOODWORK TODAY. NO, I DECLINE PRE‐ANESTHETIC BLOODWORK AT THIS TIME. I understand the need for my pet to have the pre‐anesthetic blood screen. Pain medication, antibiotics and anti inflammatory medications are recommended to ease the pain and prevent any infections during and following surgery and we provide an affordable package for you. POST SURGICAL INJECTION PACKAGE INCLUDES: PAIN INJECTION, ANTIBIOTIC INJECTION AND ANTI‐ INFLAMMATORY INJECTION: TOTAL COST IS $30.00POST SURGICAL INJECTION PACKAGE INCLUDES: PAIN INJECTION, ANTIBIOTIC INJECTION AND ANTI‐ INFLAMMATORY INJECTION: TOTAL COST IS $30.00 APPROVE DECLINE TAKE HOME MEDICATION PACKAGE INCLUDES: PAIN MEDICATION, ANTI‐INFLAMMATORY MEDICATION, AND ANTIBIOTICS: TOTAL COST IS $30.00 APPROVE DECLINE understand that anesthesia carries risks and I give 101 spay and neuter clinic permission to place my animal under anesthesia. I authorize the use of appropriate anesthetics, and other medications, and I understand that hospital support personnel will be employed as deemed necessary by the Veterinarian. I realize that results cannot be guaranteed. I have read and understand this authorization and consent.InitialsSignaturePhone:Date MM slash DD slash YYYY
