Anesthesia Release Form

Owner's Name

I, the undersigned, certify that I am the owner, or an authorized agent for the owner, of the animal(s) listed above. I Authorize the Doctor(s) and staff of Four Paws at Fulshear Veterinary Clinic to perform the procedures listed above and/or on the estimate for my animal. I also authorize the administration of pain-relieving, sedating, and anesthetizing medications, and necessary and appropriate medical, surgical, diagnostic, nursing and emergency treatments for my animal. 

FOUR PAWS AT FULSHEAR VETERINARY CLINIC offers the safest anesthetic and surgical procedures available for your pet, however, there is always an element of risk with any anesthetic procedure, and occasionally problems may occur during or after any medical or surgical procedure. For example, mild nausea, adverse drug reactions, prolonged recovery, and extremely rarely, death may occur. 

FOUR PAWS AT FULSHEAR VETERINARY CLINIC uses "Isoflurane" as the general anesthesia agent for your pet. This provides superior anesthetic safety and smooth induction and recovery. We also require that all pets have blood tests prior to administering anesthesia. These tests help identify underlying problems that may increase risks to your pet during anesthesia and in the future.   

Health Concerns Before Surgery:
Is your pet currently experiencing vomiting, diarrhea, not feeling well, or any other health concerns?

If Yes, please immediately call our clinic and inform our staff before surgery. These symptoms may require treatment prior to anesthesia, as being unwell can increase risks during the procedure.

Pre-Anesthetic Laboratory Testing Requirement

To ensure your pet’s safety during anesthesia, pre-anesthetic bloodwork is required for all pets aged 4 years and older prior to any procedure involving sedation or general anesthesia. Bloodwork must be completed within 72 business hours of the scheduled procedure. If your pet has had bloodwork done within the past 3 months, and those results have been reviewed and approved by the doctor, repeat testing may not be necessary. This allows our veterinary team to create a safe, personalized anesthesia plan. If lab work is not completed or approved within the required timeframe, your pet’s procedure may need to be rescheduled.

For pets under 4 years of age, pre-anesthetic bloodwork is optional but strongly recommended. This screening helps identify underlying medical conditions, such as liver or kidney concerns, and checks for infection, anemia, or low platelets — all of which are important for safe anesthesia and proper blood clotting during surgery.

Client Acknowledgment
Cold-Laser Therapy: FOUR PAWS AT FULSHEAR VETERINARY CLINIC offers cold-laser therapy treatment following surgery or dental cleaning to help promote healing, reduce inflammation, decrease the risk of infection and help dental cleanings last longer. Laser therapy also helps control pain. The cost of this service is $35.
Nail Trim: The cost of this service is $24.50
Microchip: FOUR PAWS AT FULSHEAR VETERINARY CLINIC can also implant a microchip while your pet is under sedation. Microchips are an excellent way to find your pet should the unforeseen happen and your pet is lost. The cost for a microchip is $64.40 which includes registration.
The following section is for dental procedures only:
DENTAL PROCEDURES: During cleaning the teeth and performing dental x-rays, we may find that further treatment is needed. Such treatments may include minor or major tooth extractions, antibiotic fillings, and removal of excess gum tissue (does not list all possible treatments that may be necessary). The required treatments can be determined after a thorough oral exam upon sedation, where in which, we can then call you with an update prior to proceeding with treatments should you choose.
PLEASE BE AWARE that if you prefer us to call you prior to proceeding with treatment after cleaning and polishing the teeth, if we are unable to contact you within 20 minutes, we will then be forced to wake up your pet from anesthesia WITHOUT completing the treatments. 
Oravet Dental Sealant: Following the dental, FOUR PAWS AT FULSHEAR can apply Oravet to your pet's teeth. Oravet is a barrier sealant that binds to the tooth enamel, creating an invisible barrier that helps prevent plaque forming bacteria from attaching to the tooth. This can also allow dental results to last longer. The cost for Oravet application is $40.31.
Oral Cerenia: Has your pet been given oral cerenia?
Cardiopulmonary Resuscitation, or CPR, is the emergency treatment used for cardiac and/or respiratory arrest. This means that a patient's heart has stopped beating and/or the patient has stopped breathing. If these events occur, and CPR is not instituted, the patient will die. CPR includes manual chest compressions, intubation with manual respirations, oxygen supplementation, intravenous fluids, and the administration of emergency drugs. If my pet should suffer cardiac arrest; I request full resuscitation efforts with the understanding additional financial responsibility will result even if CPR measures are unsuccessful, resulting in loss of life.
Client Acknowledgment:
Pre-anesthetic Laboratory Testing
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