Haven Lake Animal Hospital

300 Milford Harrington Highway
Milford, DE 19963

(302)422-8100

www.havenlakeanimalhospital.com


Surgical Release Form

Surgical Release Form

Client Name (required)
First Name (required)
Last Name (required)
E-Mail Address (required) :
Phone (Home)
Phone TypePhone Number
Phone (Cell) (required)
Phone TypePhone Number (required)
Phone (Work)
Phone TypePhone Number
Pet Name

Procedure

Date of Procedure

I authorize Haven Lake Animal Hospital to administer anesthesia and perform surgery on my pet.
I understand that some risks always exist with anesthesia and/or surgery and that I am encouraged to discuss any concerns I have about those risks with my attending veterinarian before the procedure is initiated. Should some unexpected life- saving emergency care be required, Haven Lake Animal Hospital's staff has my permission to provide such treatment. I agree to pay for such care by cash, check, Care Credit, Mastercard or Visa.
Pre-anesthetic recommended blood profile

Accept
Decline
Already Done


Parasite check/ Fecal

Accept
Decline
Already Done
N/A


Heartworm/Tick

Accept
Decline
Already Done
N/A


FELV-FIV Test

Accept
Decline
N/A


Vaccinations Update

Accept
Decline
N/A


Dental Cleaning

Accept
Decline
Already done


Sanos Sealant Dental Treatment

Accept
Decline
I need more information


Purpose of Admission

We will perform a pre anesthetic exam on your pet before administering anesthesia.
If your pet is admitted to this hospital and is found to have fleas or ear mites, your pet(s) will be treated at the owner's expense.

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