Anesthesia/Surgery ReleasePlease enable JavaScript in your browser to complete this form.Date *Name *FirstLastEmail *Pet's Name *Presented forProcedure.Advances in anesthesia have made elective procedures safer, with a low rate of anesthetic complications. However, complications can arise because of undiagnosed pre-existing conditions. At Blue Door Veterinary Services, we do everything we can to prevent complications including a preanesthetic examination and blood work screening prior to the procedure. In certain rare circumstances, a condition may exist that is not evident on physical examination or pre-anesthetic screening, which could result in an anesthetic complication. To help avoid complications, all patients undergoing anesthesia will have an intravenous catheter placed to allow for administration of fluids during the procedure (to help support blood pressure) and to facilitate emergency treatment if needed. It may be necessary to shave or clip hair from the IV catheter site and/or other areas. Patients will be monitored during and after anesthesia. Pain relief medication will be administered in hospital and dispensed for use at home at the discretion of the doctor.Blue Door Veterinary Services requires pre-anesthetic screening prior to all anesthetic procedures. This information helps us know whether we need to take additional precautions with your pet or postpone the procedure pending treatment. All costs associated with pre-anesthetic testing are included in your surgery procedure cost; however, if the procedure is postponed due to the results of the testing or examination, you will be billed separately for the testing that was completed.While your pet is under anesthesia, there are some procedures you may elect to have performed for your pet's safety and comfort. These services are charged in addition to the procedure cost if chosen. As microchips are a means of permanent identification should your pet get lost, do you wish a microchip implanted today?YesNoDo you wish to have your pet's nails trimmed while under anesthesia?YesNoDo you wish to have your pet's ears cleaned while under anesthesia?YesNoDo you wish to have your pet's anal glands emptied while anesthetized?YesNoDo you have any other requests/concerns we should look into today while your pet is under anesthesia?YesNoIf yes, please explain additional concerns or requests:It is important for your pet to fast for at least 6 hours prior to an anesthetic procedure. When did your pet last eat food or treats?Does your pet get daily medications? If so, which medications and when did they last receive their last dose? If this procedure is a dental procedure, dental x-rays and extractions may be recommended based on findings during the procedure. Do you authorize the doctor to exercise best medical judgement and perform necessary extractions and treatments without additional contact? YesNo, Please Call or Text to Discuss With my signature below, I certify that I have read, understand and agree to the above statements and authorize Blue Door Veterinary Services, LLC to treat my pet as written above. I further acknowledge that I am responsible for all costs associated with this procedure and additionally requested services.Signature: *Date *Submit