Bronson Veterinary Services

Bronson Veterinary Services SURGERY RELEASE FORM Weight: ______

Owner: ______Patient:______Age: ______

Main Reason for Admittance: ______Date: ______

Dog Vaccines: Cat Vaccines: Other Services:

 DHPP $28.00  FVRCP $17.00  Fecal $16.00

 DHLPP $32.00  FVRCP w/Leukemia $25.75  Check ears – Cytology $25.00

 DHLPP w/Lyme $47.50  FIV $25.00  Express Anal Glands $15.00

 Rabies $13-$17.50  Rabies $13-17.50  Yesterday’s News $18.00

 Kennel Cough $20.00  FELV/FIV/Heartworm Test $45.00  Deworm ($ by weight)

 Heartworm/Blood Parasite Screen $36.50  Nail Trim Complimentary

*There will be a $25.00 Pre-vaccination Exam charge with vaccines.  Histopathology $100.00

Other: ______ Microchip $ 50.00

We recommend that pre-anesthetic blood tests be performed prior to the administration of anesthesia. These tests can help us detect anemia, dehydration, diabetes, kidney disease and liver disease. All these conditions can contribute to complications in anesthesia and surgery. Bloodwork is required for all patients over 8 years of age undergoing anesthesia. These are our general recommendations for all surgeries.

Under 5 years of age: Presurgical panel/PCV _____ Accept ($50.00) _____ Decline

5-8 years of age (Recommended but not Required): CBC/Full Panel w/ Electrolytes _____ Accept ($130.00) _____ Decline

8 years and older (Required) CBC/Full Panel w/ Electrolytes _____ Accept ($130.00) _____ Decline

Recommend Thyroid for ages 5 and above _____ Accept ($ 40.00) _____ Decline

We recommend intravenous fluids during the surgery to maintain blood pressure and ensure your pet’s post-surgery comfort. There will be an additional charge of $50.00 for intravenous fluids. _____ Accept (up to $50.00) _____ Decline (Initial Accept or Decline)

All pets are routinely given pain medication prior to the induction of surgery and this fee is included in your surgical procedure. We also recommend post-surgery pain medication. This not only helps your pet feel more comfortable, but it also has been proven to speed the healing and recovery process. The pain package includes an injection post-surgery for immediate comfort and oral pain medication for your pet to be taken at home. The pain package is an additional $40.00. _____ Accept ($40.00) _____ Decline _____ Injection Only ($20.00) (Initial Accept or Decline)

I hereby authorize and direct the veterinarians of Bronson Veterinary Services to perform the procedures and additional diagnostic and/or treatment procedures as deemed advisable for my pet. The nature of the procedure(s) has/have been explained to me and no Owner’s Signature: ______Date: ______

Phone number(s) where you can be reached today: ______Text Me With Updates on My Pet  Bronson Veterinary Services SURGERY RELEASE FORM Weight: ______guarantee has been made as to the results or cure. I understand that there may be risks involved in some of these procedures. I also understand that if my pet has fleas they will be treated at owner’s expense.

I agree to pay, in full, for services rendered, including those deemed necessary for medical or surgical complications or unforeseen circumstances. Any estimate or charges for the planned procedures are only approximations, and the final bill may be greater or less than these amounts. All Services Must Be Paid For When Your Pet Is Released.

I hereby grant Bronson Veterinary Services permission to use my likeness in a photograph/video or any photo/video that I upload to the Bronson Veterinary Services Facebook page or designated repository (e.g. Flickr) in any and all of its advertising or collateral materials, including the Bronson Veterinary Services website (bronsonvetservices.vetstreet.com) without payment or any other consideration. I hereby irrevocably authorize Bronson Veterinary Services to edit, alter, copy, exhibit, publish or distribute any photos/videos taken of or by me for purposes of publicizing the Bronson Veterinary Services or for any other lawful purpose.

Owner’s Signature: ______Date: ______

Phone number(s) where you can be reached today: ______Text Me With Updates on My Pet 