I understand that any anesthetic or surgical procedure(s) that I have authorized carries a serious risk and that unforeseen conditions may arise. I accept the veterinarian's professional judgement and I agree to indemnify the Platte Lake Veterinary Clinic, its servants or agents from any loss or liability which may incur. I also do hereby acknowledge that I understand that there are no guarantees either expressed or implied that the procedures authorized will be without complications from unexpected events beyond the veterinarian's and hospital's control. I have also had the likely fees explained to me and accept responsibility for payment of these fees at the time of the patient's discharge.

Name *

Phone Number *

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Clear Signature

Date *

I am the owner (or owner's agent) of (PET'S NAME).

I understand that I am authorizing performance of the following procedure(s): (please initial)

others

Front Declaw
Front and Back Declaw

PRE-ANESTHETIC TESTS:

TEST #1 (COST $118.45) The combination of blood tests we recommend for the healthy young pet (under the age of 5) and REQUIRE for the pet that is 5 years old or older is as follows:

-* BUN, Creatinine, ALT, ALK, Total Protein, Glucose (kidneys, liver, diabetes)
-* CBC (Anemia, Infection, Clotting) -* Electrolytes (sodium, potassium, chloride)

TEST #2 (COST $134.75) The combination of blood tests we recommend for the older pet (5 years old and older) is as follows:(This test is also recommended for pets under the age of 5)

-* BUN, Creatinine, ALK, ALT, Glucose, Total Protein, Total Bilirubin, Phosphorus, Amylase, (kidneys, liver, diabetes) -* CBC (anemia, infection, clotting)
-* Electrolytes (sodium, potassium, chloride)

PLEASE INITIAL ONE OF THE FOUR TEST CHOICES:

Please initial your test choice, "a" or "b".

Consent Form

PRE-ANESTHETIC TESTS:

You can call after 2:00 p.m. on the day of the surgery to check on your pet's status.

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