Grooming/Bath Anesthesia Release Form Grooming/Bath Anesthesia Release Form Grooming/Bath Anesthesia Release Form Name * Name First First Last Last Pet's Name * Date * What medications is your pet currently on? * When was the last dose given? Any allergies to medications? * *** PLEASE READ CAREFULLY AND SIGN *** Your pet is being admitted today for grooming and/or a bath. Most of the time anesthesia is not needed for this procedure, however, if we feel that your pet is overly nervous, anxious or un-cooperative, we may recommend anesthesia. A physical examination will be performed prior to the anesthesia. We always recommend a pre-anesthetic blood screen, like those performed in human hospitals, to ensure that your pet is at low risk for any medical complications. We also recommend an EKG for pets over 8 years of age or with any known heart conditions. This test alerts us to any potential problems. Please administer anesthesia if necessary. * Yes No Please complete the blood test prior to anesthesia * Yes No The additional fee for the pre-anesthetic blood test with ECG is $110.00. If fleas are present upon examination, we will apply a flea elimination product to your pet and the charge will be added to your invoice. Please understand that this is necessary to safeguard our hospital. Please complete the EKG prior to anesthesia. * Yes No I can be reached at the following phone number/s: Home Phone Cell Phone Would you like us to text you when your pet is ready to go home? * Yes No Email * To ensure the safety of all animals in our care, please be aware that if your pet is not fully vaccinated and contracts an illness while staying with us, we cannot be held responsible for any resulting medical cost. * I understand Date * Signature * signature keyboard Clear Captcha Submit If you are human, leave this field blank.
