Surgery & Dental Release Form

If you suspect your pet may have had access to food after midnight, please let your intake technician know. We may need to delay or postpone the procedure today, as patients under anesthesia cannot control their airways and may inhale any vomited material, which can lead to a potentially life-threatening aspiration pneumonia.

If live fleas are found on my pet at any time during their hospitalization in our clinic, we will administer an oral/rectal Capstar to kill any fleas present. *This medication will only last for 24 hours, so your pet will need to start an effective flea preventative to keep the flea infestation from recurring.

I, the undersigned owner or agent of the pet identified above, authorize the staff of Pittsboro Animal Hospital to perform the above procedure(s) within the parameters described on the attached estimate, including, but not limited to: administration of pain relief medications, sedatives and/or anesthetics, as well as any necessary and appropriate medical, radiological, surgical, nursing, diagnostic, post-operative recovery, and/or emergency care for the animal. I assume full financial responsibility for all charges and services incurred for the above animal and understand that full payment is due at the time of discharge. I have been advised as to the nature of the procedure(s) and the potential risks. I understand that some risk always exists with anesthesia and/ or surgery and I have discussed any concerns I have about those risks with the primary/attending veterinarian before the procedure(s) is/are initiated.