Surgery Authorization

The following information is necessary in order to serve you and your pet better and give you more personal attention. Please fill out the form completely.

Like you, our greatest concern is the well being of your pet. Before putting your pet under anesthesia, we will perform a full physical examination. However, many conditions, including disorders of the liver, kidneys or blood, are not detected unless blood testing is performed. Such tests are especially important before any kind of surgery. If your pet is going to be placed under anesthesia, we strongly recommend pre-anesthetic testing. Anesthesia is extremely safe for healthy pets. But, if your pet is not healthy (and sometimes it's hard to tell without testing), complications can occur both during and after the anesthetic procedure. We can minimize potential risk when we know the health status of your pet before administering anesthesia. Pets can't tell us when they don't feel well. A healthy-appearing pet may be hiding symptoms of a disease or ailment. For example, a pet can lose up to 75% of kidney function before showing any signs of illness. Testing helps us evaluate the health of your pet's liver and kidneys, so we can avoid problems related to anesthesia. Results will be immediately available to examine before anesthesia and/or surgery. The total cost of these important tests is $55.00. Learn more about what we learn from testing at Why Bloodwork is Critical. Yes - I want my pet to have a pre-anesthetic blood screen No - I do not want my pet to have a pre-anesthetic blood screen

I hereby authorize performance of the following surgical procedure(s):

Dewclaw Removal: Yes No Deciduous Teeth Extraction: Yes No

Owner: Pet's Name: Email: Phone number where I can be reached:

I understand there are risks involved in all surgical procedures and when anesthesia is involved. I realize there is no guarantee nor warranty that can be ethically or professionally made regarding the results or cure. I understand that I assume financial responsibility for all services rendered and payment is due on the date of discharge. By typing my name in the box constitutes a valid electronic signature and with the submission of this form shall act as my legal signature. Signature: Date:

*Type the text you see in the image above.

Cherokee Animal Clinic
P O Box 416
(Hwy. 84 East)
Rusk, TX 75785

For Appointment or Emergencies
Call 903-683-5315

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