Anesthesia Release Form

Fortunately advances in anesthesia and surgery have made routine procedures relatively safe, with a low rate of complications. However, occasional problems can occur due to pre-existing conditions not evident during routine examinations.
To possibly avoid these problems, we recommend that your pet be screened prior to surgery by means of a blood panel, which will tell us more about your pet’s kidney and liver function, both of which are very important to know about before putting your pet under anesthesia.
Research has shown that 30% of all dogs and cats that had “normal exam” displayed some bloodwork abnormalities. This is why we highly recommend the pre-anesthetic bloodwork.
Our pre-anesthetic or “Prep Profile” is offered at a special price to you at only $47.50. (Normally a complete panel runs $93.30)
  • In the event that emergency treatment is required and I cannot be reached, I authorize Dr. Menks’ and Associates to perform such medical and surgical treatment as is necessary to preserve the life of my pet (the patient) until I can be contacted for further authorization. I understand that no guarantee of successful treatment is made or implied.

    I agree to pay for services rendered at the time my pet is discharged from the hospital or when service is otherwise terminated.

    I certify that I have read and fully understand this authorization for medical and/or surgical treatment, the reason why such medical and/or surgical treatment is considered necessary, as well as its advantages and possible complications, if any. I hereby release Dr. Menks’ and Associates from any and all claims, except claims for negligence arising out of or connected with the performance of their pet’s treatment.