Surgery Release Form

SURGERY RELEASE FORM

Procedure to be preformed:

Required Procedures

Initial: Post surgical pain medication is required for all surgical procedures.

  • Canines will be sent home with oral medication, cost is determined by weight, usually $25-$30
  • Felines will receive a pain injection that will last for 3 days. Cost is $35

Initial: Extraction of retained baby teeth at the cost of $15 per tooth.

Initial: Extraction of diseased adult teeth at a minimum cost of $40 per tooth

Optional Procedures (Check box if requested)

I, the undersigned, do hereby certify that I am the owner (duly authorized agent for the owner) of the animal described above; that I hereby give Dr. Mark Sprayberry, his agents, servants, or representatives full and complete authority to perform the surgical procedure said above, and to perform any other procedure that, at their discretion, may be useful to promote the health of the above-described pet, and I do hereby and by the presents forever release the said doctor, their agents, servants, and representatives from any and all liabilities arising from said surgery on said animal. I understand that in all procedures performed there is a certain amount of risk involved and that I fully accept such risks.

It is further understood that all charges shall be paid in full upon release from hospital. I hereby state that my animal has been fasted for at least eight hours prior to surgery. I also understand that I will be charged for a flea treatment if it is found that my pet has fleas.