Animal Hospital of Panama City Beach
Anesthetic/Surgery release form
Client name: ______
Telephone: Day ______Cell______Evening ______
Pet’s Name: ______D.O.B. ______Breed ______Sex ______
Procedure(s) to be performed: ______
I understand and agree that all anesthesia and surgery involves a certain amount of risk to my pet, results cannot be guaranteed, and the Animal Hospital of Panama City Beach will not be held liable. If any unforeseen medical/surgical needs arise, I herby consent and authorize the performance of procedure(s) or operation(s) necessary and desired in the exercise of the veterinarian’s professional judgment.
I understand that I assume financial responsibility for all services rendered, and that payment is due on the date of surgery. Any medications prescribed and supplies purchased will be at an additional charge.
All Surgeries include the following:
* Pain medication during and after surgery.
* Induced with Propofol and maintained on Isoflurane and Oxygen.
* IV Catheter placed in Cephalic Vein and fluids administered during the procedure.
* Heart Rate and Respiration is monitored and recorded for our records.
Pre-Anesthetic Blood Profile
* Blood work is highly recommended for all pets.
* Blood work is required for all older pets.
___ Basic Profile: (Liver, Kidney, glucose, Total protein and complete blood count) $68.50
___ Comprehensive Profile: (Includes basic profile plus electrolytes and ECG) $89.00
Additional Services Provided While Sedated
___ Oravet (Sealant applied on enamel to slow down tarter build up) $35.00
___ ResQ Microchip insertion & Registration $45.00 ____ Nail Trim-Regular $14.25
___ Ear Flushing Comprehensive $38.95-$49.50 ____ Nail Trim-Short with cautery $42.95
___ Hygiene Cut $17.95 ____ Dematting/Brushing $18.95
Our Veterinarians encourage good Client/Doctor relationships. Please ask to speak a Technician or Doctor for any concerns or inquiries.
Signature of Owner: ______
I have been informed of the importance of pre-anesthetic laboratory evaluations and the potential risks, and I decline that they be performed for my pet.
Signature of Owner: ______
Dental Procedure
Anesthetic/Surgery release form
Client Name: ______
Telephone: Day______Cell______Evening ______
Pet’s name: ______D.O.B.______Breed ______Sex ______
I understand and agree that all anesthesia and surgery involves a certain amount of risk to my pet, results cannot be guaranteed, and the Animal Hospital of Panama City Beach will not be held liable. If any unforeseen medical/surgical needs arise, I herby consent and authorize the performance of the procedure(s) or operation(s) necessary and desired in the exercise of the veterinarian’s professional judgment.
I understand that I assume financial responsibility for all services rendered, and that payment is due on the date of the surgery. Any medications prescribed and supplies purchased will be at an additional charge.
Pre-Anesthetic Blood Profile
* Blood work is highly recommended for all pets.
* Blood work is required for older pets.
____ Basic Profile: (Liver, Kidney, Glucose, Total protein, and complete blood count) $68.50
____ Comprehensive Profile: (Includes basic profile plus electrolytes and ECG) $89.00
Pain management is included with extractions. Local anesthesia will be performed if extensive extractions are performed.
Once your pet is sedated and a complete examination of each tooth is performed, pathology may be found and a particular procedure may be recommended.
____Yes, you want to be notified prior to any treatment at this number______.
____No, perform procedure under doctor’s discretion.
Additional Services Provided While Sedated
____Dental Vaccine (Porphyromonas Denticanis-Gulae-Salivosa Bacterian) $25.00 Booster in 3 weeks.
____ResQ Microchip insertion and registration $45.00 ___Nail trim-Regular $14.25
____Ear flushing comprehensive $38.95-$49.95 ___Nail trim-Short with cautery $42.95
____Hygiene cut $17.95 ___Dematting/Brushing $18.10
Our Veterinarians encourage good Client/Doctor relationships. Please ask to speak to a Technician or Doctor for any concerns or inquiries.
Signature of Owner: ______
I have been informed of the importance of pre-anesthetic laboratory evaluations and the potential risks, and I decline that they be performed for my pet.
Signature of Owner: ______