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.

Pre-Anesthetic Blood Screening: Four Paws at Fulshear Veterinary Clinic requires running a blood screening prior to any sedation/anesthesia for patients OVER 4 YEARS OF AGE. This service is optional to those under the age of 4 years, however, is highly recommended to determine if there are pre-existing liver and/or kidney concerns that would affect your pet's ability to metabolize the anesthetic drugs being used. This also checks for any blood cell abnormalities that could indicate infection, anemia, or a decrease in platelets which are important for blood clotting during surgery. The cost for the blood panel is $93.
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 per site.
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.
Please initial.
Did your pet receive oral Cerenia the night before surgery?
Is your pet having a dental procedure?

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 so choose. 
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 $34.00. 
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 respiration, 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.
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