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Medical Release Form
Medical Release Form
Medical Release Form
Hospital Procedure, Anesthesia & Medical Authorization Release Form
Your pet is scheduled for a procedure that requires anesthesia. Like you, our greatest concern is the well being of your pet. We strongly recommend that a pre-anesthesia blood profile be performed prior to anesthetizing your pet today. The results provide vital information about the functions of the blood system and internal organs.
Profile 1 -Patients under age 8
This provides basic health evaluation of vital organs and blood system. Evaluates anemia, infection and clotting, liver & kidney functions, blood sugar.
Yes, I would like Profile 1
Profile 2 -Sick or Geriatric over age 8
Includes all tests above, and:
Detects disease and provides a detailed evaluation of vital organs and blood system.
Yes, I would like Profile 2
I authorize the recommended blood testing prior to administering anesthesia.
I decline the recommended blood test
I understand that a medical condition may exist which would be impossible to identify during a physical exam alone. I understand that my pet’s health could be at risk if such a condition goes undetected.
Microchip Identification
20% off
Permission to treat unforeseen conditions up to $50.00
Did pet eat after 6pm last evening?
Current on Vaccines?
I certify that I am the owner or authorized agent for the above animal. I hereby consent to and authorize the doctors and staff at this veterinary practice to admit this pet, and administer anesthesia, surgical procedure(s) and the following procedures as checked above.
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.
I acknowledge that I am responsible for payment in full for the above procedures and treatments at the time my pet is discharged.
Thank you for choosing Bayshore Animal Care!
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