Surgery Release Form

I certify that I am the owner, or authorized agent for the owner, of the above animal. I hereby consent to and authorize the doctors and staff at this veterinary practice to admit this pet, perform the above described procedures, and administer medications, anesthesia, surgical procedures, tests and or treatments that the doctors deem necessary for its health, safety and wellbeing while under their care and supervision. I have been advised of the nature of the procedures and the potential risks and benefits. I understand that veterinary medicine is an inexact science and that no guarantee of successful treatment can be made.

If your pet is undergoing an anesthetic procedure, rest assured that advances in anesthesia, anesthetic monitoring, and surgery have made procedures safer with a low rate of complications. Nevertheless, some obscure conditions can be detected only by diagnostic testing. Because of this, we recommend various pre-anesthetic screening tests. This testing is required for pets 6 years of age and older.

Complete blood count, chemistry panel and electrolytes: $115.50

I have been advised of this additional cost and consent to having these tests performed.

As an option to detect abnormal electrical activity in the heart, an ECG can be performed.

The cost for this test is $74.75

I consent to have the optional ECG screen test performed on my pet.

The cost of the procedure is $129.50 (general radiograph) | OFA $219.50

Small breed pets often suffer from retained deciduate (baby) teeth after their adult teeth grow in. This condition creates overcrowding of teeth, retention of food or other debris between the teeth, and tarter buildup. This, in turn, leads to bad breath and damage to gums and adult teeth.

We strongly recommend that these deciduate teeth be extracted while your pet is under anesthesia to avoid future complications. The cost for this procedure varies based the number of teeth extracted but usually ranges from $30.50 to $50.50 per extraction.

The cost for this procedure is $65.50 which included the first annual registration fee.