CARE Surgery 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.

Please, select additional services to be performed today for your pet below.

If you do not provide proof of prior vaccination that is current (within date), your pet will receive
a Rabies vaccine today as required by state law.

Valid for 1 year, unless proof of prior vaccination is provided at intake.

Requires booster vaccine in 2-4 weeks after initial vaccination, unless proof of full kitten/adult series is provided at intake.

CARE covers the initial vaccine, but you will be required to pay for the booster. Vaccines must be given by a veterinary professional in order to be accepted as valid for future veterinary care due to inability to confirm quality control for the vaccine and method of administration. (ie. not valid if given by breeder, purchased from Tractor Supply, etc.)

If you will not be able to return for a booster or have it done by your primary veterinary service provider within 2-4 weeks of the initial vaccine, we advise that you do not opt in for this vaccine as it will not be effective.

Your discharge instructions will include a packet of information that will allow you to register the
microchip with your information.

We highly recommend microchipping your pet today. If they are already microchipped, please let your
intake technican know.

You are responsible for fully covering these costs at the time of pick-up and E-collars are non-negotiable.

I, the undersigned owner or agent of the pet identified above, authorize the staff of Pittsboro Animal Hosital 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 described animal which are not covered by the CARE Voucher, and understanp
that full payment is due at the time of discharge. While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that some risk always exists with anesthesia and/ or surgery and that no guarantee or warranty has been made regarding the outcome or results that may be achieved.