PRE-ANESTHETIC BLOODTESTING,
ANESTHESIA, & SURGERY
RELEASE FORM
Please carefully read and sign this form. The following information is essential to
providing you and your pet superior care, coupled with a long-lasting personal
relationship with the Greenbrier Animal Hospital Staff.
A complete physical examination of your pet is standard procedure here at Greenbrier Animal Hospital,
however we do always recommend bloodwork prior to anesthesia. Because anesthesia always carries some rick
& anesthetic agents are removed from the body by the liver and kidneys, we recommend a Complete Blood
Count (CBC) and chemistry blood profile be performed prior to your pet undergoing anesthesia to ensure that
he/she is at low-risk during their procedure. We strongly recommend a FULL blood panel test for pets over 8
years, as they are more at risk than younger animals. Greenbrier Animal Hospital utilizes the latest technology,
thus enabling us to run blood chemistries in-house, within minutes, safely & accurately before your pet’s
procedure.
Yes, I would like my pet to have Pre-Anesthetic blood testing. ($59)
Yes, my pet is over 8 years old and I would like full panel Pre-Anesthetic Blood testing. ($122)
No, I do not want my pet to have Pre-Anesthetic blood testing.
 I hereby consent and authorize the following procedure(s) or operation(s): ________________________
 I understand that postoperative pain management is important, and authorize any medication deemed
necessary by the doctor to be administered. ($20-$40)
 I understand that if my pet is in heat, pregnant, or has recently been nursing, there will be an additional
fee for her procedure. ($20-$30)
 I understand for the health of my pet and to ensure a sanitary hospital environment, a safe prescription
flea/tick (topical or oral) adulticide will be administered if necessary. ($18-$25)
 I understand that a current Rabies vaccination, given by a veterinarian, is required for any animal
entering our hospital; and if my pet is not current, a Rabies vaccination will be administered. ($16)
The potential risks associated with anesthesia and my pet’s procedure have been
satisfactorily explained to me. I understand that all anesthetic procedures carry some risk
& authorize any life saving measures to be taken if deemed necessary. I assume full
financial responsibility for my pet.
Signature: ____________________________________ Date: _______________
Primary phone number: ________________________