Owner’s name______Pet’s name______
Phone Number Owner can be reached at today ( )
ANESTHESIA RELEASE
I understand that the doctors and staff will use all reasonable precaution against injury, escape, or death of my pet. I understand that all anesthesia involves some minimal risk to my pet and I will not hold doctor or staff responsible under any circumstances. I understand that I assume all risks.
______
Signature of Owner or Guardian Date
Pre-anesthetic blood testing which includes a Complete Blood Count (CBC) and a panel of six-blood chemistries is recommended. Pre-existing problems including: infection, liver, or kidney damage may be identified. The additional cost for the pre-anesthetic testing is $90.00. Please indicate below whether you do or do not want these test performed before anesthesia.
[ ] YES, I do want these test performed.
[ ] NO, I do not want these test performed
[ ] I do want these tests performed if medically necessary.
______
Signature Date
Save This Life Micro-chip is a micro-chip that is inserted under the skin (sub-cutaneous) for identification purposes. All micro-chips marketed today rely on a scanner to read the information on the chip. The chip utilizes a scanner frequency that can be read by most of the scanners in use today. Once the micro-chip is inserted, the service is with Save This Life. The owner goes online to SaveThisLife.com and registers and then is able to change information for free thereafter, or you may call Save This Life 855-777-7387 and they can help you at any time. The additional cost for themicro-chip is $50.00.
[ ] YES, I do want the microchip.
[ ] NO, I do not want the microchip.
[ ] My pet is already microchipped.
______
Signature Date
Owner’s name______Pet’s name______
Phone Number Owner can be reached at today ( )
ANESTHESIA RELEASE
I understand that the doctors and staff will use all reasonable precaution against injury, escape, or death of my pet. I understand that all anesthesia involves some minimal risk to my pet and I will not hold doctor or staff responsible under any circumstances. I understand that I assume all risks.
______
Signature of Owner or Guardian Date
Pre-anesthetic blood testing which includes a Complete Blood Count (CBC) and a panel of six-blood chemistries is recommended. Pre-existing problems including: infection, liver, or kidney damage may be identified. The additional cost for the pre-anesthetic testing is $90.00. Please indicate below whether you do or do not want these test performed before anesthesia.
[ ] YES, I do want these test performed.
[ ] NO, I do not want these test performed
[ ] I do want these tests performed if medically necessary
______
Signature Date
Save This Life Micro-chip is a micro-chip that is inserted under the skin (sub-cutaneous) for identification purposes. All micro-chips marketed today rely on a scanner to read the information on the chip. The chip utilizes a scanner frequency that can be read by most of the scanners in use today. Once the micro-chip is inserted, the service is with Save This Life. The owner goes online to SaveThisLife.com and registers and then is able to change information for free thereafter, or you may call Save This Life 855-237-7387 and they can help you at any time. The additional cost for themicro-chip is $50.00.
[ ] Yes, I do want the microchip.
[ ] No, I do not want the microchip.
[ ] My pet is already microchipped.
______
Signature Date