Canine Authorization for Anesthesia and/or Elective Surgery

  • Canine Patient Information

  • Physical Exams and Blood Analysis

    Each patient is physically examined before anesthesia is administered. Risks do exist with anesthesia and surgery; therefore, we encourage clients to authorize pre-anesthetic blood work. (Required for pets over 5 years of age)
  • Elective Pre-anesthetic Blood Work Authorization (includes CBC, BUN, Creatinine, ALKP & ALT (liver & kidney enzymes), Glucose, & Total Protein) STRONGLY RECOMMENDED

  • Elective Pre-anesthetic Chest Radiographs Authorization STRONGLY RECOMMENDED (Required for pets over 8 years of age)

  • I am the owner or agent of the above described animal and have the authority to execute this consent. I hereby consent and authorize the performance of the above listed procedure(s). I authorize the use of appropriate anesthetics and/or other medications deemed necessary to complete the listed procedure(s). I also understand the nature of the procedure(s) and understand that risks may be involved if sedation or anesthesia is employed. I also recognize that results cannot be guaranteed. I accept full financial responsibility for the services rendered on behalf of this patient. I understand that payment is due in full upon release of this patient. Payment may be made by cash, check, Credit card, or Care Credit. I understand that Waterloo Animal Hospital, PLLC does not have a payment plan or extended credit plan.
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