Surgical Authorization Form

Your pet is scheduled for a procedure that involves anesthesia. Like you, our greatest concern is the well-being of your pet. Therefore, a Pre-Anesthetic Blood Profile is necessary to screen for kidney or liver problems and to check for anemia. This profile may greatly reduce the risk of anesthetic complications as well as identify medical conditions that may require treatment.

While recovering from anesthesia, your pet will receive an injection for post-surgical pain relief. We require, for the comfort of your pet, that pain management be continued for three days after surgery. Injections will be given in the hospital and medications will be dispensed for home use. There will be an additional charge for this Extended Pain Management.

I, the undersigned, do hereby certify that I am the owner (or duly authorized agent for the owner) of the animal described above, that I do hereby give Markham Animal Clinic, their agents, and/or representatives full and complete authority to perform the core dental procedure described above and to perform any other procedure that, at their discretion, may be useful to promote the health of my pet. I do hereby release the said doctor, agents, or representatives from any and all liability arising from said procedure on said animal. I understand that all precautions will be taken to insure said patient’s safety and there are risks involved. My signature below makes me solely responsible for the charges listed for the procedures performed on my pet. I accept and agree to the terms of this treatment plan and procedure. I understand that all payments are due in full prior to discharge. The treatment plan provided for this procedure is subject to vary and additional costs may incur depending on the complications and/or unexpected conditions. I understand the veterinarian will discuss these changes, as necessary.