Anesthesia Release – General Surgery


Patient Name(Required)

Name of contact person:(Required)

This person is:(Required)

In the event you or your authorized contact person are not reachable, would you prefer us to proceed with any additional recommended treatment? Please select your preference:(Required)

Telephone is our primary means of contacting you regarding your pet’s procedure, however we sometimes email updated estimates, forms, home care instructions, etc.


FEMALE DOGS BEING SPAYED ONLY – HEAT CYCLE – What are the approximate dates of your dog's last heat cycle (beginning-end)?

MM slash DD slash YYYY

MM slash DD slash YYYY


(the earliest available time is 2:00 pm)

(the latest available time is 5:30 pm)
Do you have Pet Insurance?(Required)

If yes, do you plan on submitting the final invoice for insurance reimbursement?(Required)

MM slash DD slash YYYY


Please complete no later than 7am on the procedure date
I have been informed of the fasting requirements for anesthesia and will not/have not fed by pet since 11pm the night before surgery: *(Required)

Is your pet on any medications?(Required)

Have you recently applied or given a flea medication to your pet?(Required)

Does your pet have an ID Microchip?(Required)

What's Next

  • 1

    Call us or schedule an appointment online.

  • 2

    Meet with a doctor for an initial exam.

  • 3

    Put a plan together for your pet.