HAMILTON ANIMAL HOSPITAL
21552 Brookhurst St. Huntington Beach, Ca.92646
(714) 964-4744
General Anesthesia & Surgery
Optional Procedure Release Form
Every procedure that requires the use of general anesthesia involves some risk. Your pet’s medical team,
state of the art hospital design and medical monitoring equipment are the basis for minimizing the risks
during general anesthesia. The procedures described below are recommended by our doctors, however, we
give you the option to decline them.
You may choose from the optional procedures below
or select all three and receive a package discount.
Pre-Anesthetic Blood Screening Test
Physical examination before anesthesia is very important to detect obvious signs of ill health. However,
some sub-clinical signs of illness or organ failure in the early stages can only be detected by performing
bloodwork. Early detection of possible illness can be key to treatment and ultimately reduce the long-term
costs of care. Even young healthy-appearing kittens and puppies can have subclinical conditions which
would increase the risk of anesthesia. With this blood panel, we can examine blood proteins, liver and
kidney enzymes, blood sugar, and a full red blood cell (RBC) count. The test can verify that vital organs are
functioning normally and reassure us that anesthesia should not pose extra risk. We will cancel the
anesthetic procedure and contact you immediately if any abnormalities are detected. Most likely, we can do
further testing that day, if needed, in order to more accurately diagnose the problem.
I accept
□ I decline □ Initials: ____________
I.V. Catheter and Fluids
This helps maintain proper blood pressure and hydration and it adds an increased margin of safety should
unexpected complications develop by already having intravenous access for emergency drug
administration.
I accept
□ I decline □ Initials: ____________
Peri-Operative Pain Management
An injection can be given peri-operatively that will help to ease the pain from surgery. The analgesic
medication will control the pain during the surgery and in recovery, however, at some point, the medication
will wear off. In some cases, the doctor may also recommend and prescribe oral analgesics for at home use.
In these cases, treating for pain peri-operatively, can also make the at home medicines more effective. If
prescribed, the at home pain medications are at an additional cost not included in this package.
I accept
□ I decline □ Initials: ____________
All Three Optional Items at Package Discount
All three of the items described above are recommended by our doctors, but not necessarily required. To
make them more affordable and accessible to you and your pet, we have grouped the items together at a
discounted rate. Please inquire, with the front desk, regarding the cost of the Pre-surgical Anesthetic
Options.
I accept the Pre-Anesthetic Options and understand the additional cost
□ Initials: _____________
□ Initials: _____________
I decline the Pre-Aneshtetic Options and understand their importance
I understand that I am requesting an anesthetic procedure for my pet. Furthermore, I understand that
there are risks involved which can be minimized, but not eliminated, by performing the procedures
described on this form. I am aware that these procedures are recommended by Hamilton Animal Hospital
and it’s agents and that they will add to the costs of the procedure being performed.
Signed: __________________________ Date: ___________ Pet’s Name: ________________