Your pet is in for anesthesia or an elective surgery and will be given a full physical examination prior to the administration of any anesthetic agents. However, in order to reduce the risk of problems during surgery, it is advised that a pre-surgical blood profile be performed. This profile will help rule out any pre-existing internal problems that may not be evident during a physical examination, but that could lead to complications. There is a $32.00 fee for this important lab test. We realize this increases the cost of the surgical procedure, but we feel it is important to offer the best care for your pet.

Consent (Please initial below)

_______YES, perform the recommended blood work prior to surgery on my pet.

_______ NO, I have decided to refuse the blood work at this time and request you proceed with the procedures as discussed. I fully understand and accept the risk of performing this procedure without the recommended blood work.

We recommend the administration of pain medication after surgery to reduce the pain and discomfort of your pet. A less painful recovery results in a faster recovery. This service ranges in cost from small ($15.05), to medium ($22.00), to large ($30.00).

Consent (Please initial below)

_______YES, please administer post-surgical pain medication to my pet, in order that my pet recover faster and with less pain.

_______ NO, I have declined the post-surgical pain medication administration. I understand my pet may experience more discomfort, which may prolong the recovery process.

Signature: _________________________________ Date: ________________