Surgical / Anesthesia Release Form

Please complete this form before your visit.

A Pre-Anesthesia Blood Screen is recommended for all pets but is required for pets 7 years of age and older, prior to anesthesia. If all of the tests are normal, it does not guarantee that your pet will not have an anesthetic reaction, but it does tell us that your pet is healthy and in a low-risk category. If any of the test results are abnormal, the doctor will call you to discuss how to proceed. This Blood Screen includes the following tests:

Complete Blood Count: Detects anemia, infections, and clotting disorders.

Bun & Creatine: assess kidney function.

Glucose: detects diabetes.

ALT & ALKP: assess liver function.

Total Protein: detects dehydration.

For pets having dental procedures:

For pets having surgical removal of masses:

For pets having general surgery (spays, neuter, etc):

I hereby certify that I am the owner of (or duly authorized agent for the owner) of the above-mentioned pet, and do hereby give Novey Animal Hospital permission to perform any other procedures that may be necessary to promote the health of my pet.

I understand that all reasonable precautions will be used to prevent the injury, escape, or death of my pet, and I do hereby release Novey Animal Hospital and its employees or representatives from any liability arising from said procedures on said animal.