Owner: *

Patient: *

Are you OK to receive text message updates? *

Yes
No

Phone #: *

Email *

Additional Emergency Contact Number:

I authorize the performance of the following procedures by the use of anesthetic drugs:

I do hereby certify that I am the owner or authorized agent of the animal described above.

I do hereby certify that I am the owner or authorized agent of the animal described above. *

I have read and agree to the above statement.

I understand that anesthesia and sedation carry inherent risks, including the possibility of serious injury or death. These risks exist with any procedure requiring general anesthesia or intravenous sedation. I acknowledge that the doctors and staff of Snake River Veterinary Center will take all reasonable precautions to prevent injury, escape, or death of my pet. In the absence of gross negligence, I release Snake River Veterinary Center and its staff from any and all responsibility or liability.

I understand that anesthesia and sedation carry inherent risks, including the possibility of serious injury or death. These risks exist with any procedure requiring general anesthesia or intravenous sedation. I acknowledge that the doctors and staff of Snake River Veterinary Center will take all reasonable precautions to prevent injury, escape, or death of my pet. In the absence of gross negligence, I release Snake River Veterinary Center and its staff from any and all responsibility or liability. *

I have read and agree to the above statement.

I understand that unforeseen conditions or changes in my pet’s medical status may be discovered during treatment and may require modifications to or an extension of the original treatment plan. If this occurs, a staff member will make reasonable efforts to contact me to discuss the findings and update the estimated cost. If I cannot be reached at the emergency contact information provided, I authorize Snake River Veterinary Center to proceed with any medical treatment deemed necessary to preserve my pet’s health or to reduce the risk of more extensive or costly care in the future.

I understand that unforeseen conditions or changes in my pet’s medical status may be discovered during treatment and may require modifications to or an extension of the original treatment plan. If this occurs, a staff member will make reasonable efforts to contact me to discuss the findings and update the estimated cost. If I cannot be reached at the emergency contact information provided, I authorize Snake River Veterinary Center to proceed with any medical treatment deemed necessary to preserve my pet’s health or to reduce the risk of more extensive or costly care in the future. *

I have read and agree to the above statement.

I accept full financial responsibility for all charges incurred. I understand that Snake River Veterinary Center does not accept payment plans directly. Payment plan options may be available through Cherry Payment Solutions (AOC). All balances are due in full at the time of patient discharge.

I accept full financial responsibility for all charges incurred. I understand that Snake River Veterinary Center does not accept payment plans directly. Payment plan options may be available through Cherry Payment Solutions (AOC). All balances are due in full at the time of patient discharge. *

I have read and agree to the above statement.

I understand that if my pet is found to have parasites (external or internal), he/she will be treated at my expense.

I understand that if my pet is found to have parasites (external or internal), he/she will be treated at my expense. *

I have read and agree to the above statement.

I agree that if I fail to pick up my pet at the prearranged time, I will be charged a boarding fee of $38 per day for each day the animal remains at Snake River Veterinary Center. If my pet is not picked up within five (5) days of the agreed-upon discharge time, Snake River Veterinary Center may consider the pet abandoned and reserves the right to notify appropriate authorities and dispose of the pet as permitted by law.

I agree that if I fail to pick up my pet at the prearranged time, I will be charged a boarding fee of $38 per day for each day the animal remains at Snake River Veterinary Center. If my pet is not picked up within five (5) days of the agreed-upon discharge time, Snake River Veterinary Center may consider the pet abandoned and reserves the right to notify appropriate authorities and dispose of the pet as permitted by law. *

I have read and agree to the above statement.

I acknowledge that the major risks associated with the planned procedure, including the risk of death under anesthesia, have been explained to me by my veterinarian or a member of the clinic staff. I understand that Snake River Veterinary Center will provide supportive care, as deemed medically necessary by the veterinarian, to help prevent cardiac arrest. The cost of any medications or treatments used for supportive care will be the responsibility of the owner.

I acknowledge that the major risks associated with the planned procedure, including the risk of death under anesthesia, have been explained to me by my veterinarian or a member of the clinic staff. I understand that Snake River Veterinary Center will provide supportive care, as deemed medically necessary by the veterinarian, to help prevent cardiac arrest. The cost of any medications or treatments used for supportive care will be the responsibility of the owner. *

I have read and agree to the above statement.

Definition of Supportive Care vs. Cardiopulmonary Resuscitation

Supportive Care - During anesthesia and/or medical procedures, patients are continuously monitored by trained veterinary technicians and electronic monitoring equipment. If your pet’s heart rate, respiratory rate, or other vital parameters fall outside normal ranges, the veterinarian may initiate supportive care. Supportive care may include the administration of medications or adjustments in anesthesia with the goal of stabilizing your pet and returning vital signs to acceptable levels.

Cardiopulmonary Resuscitation - (CPR) is performed when a patient experiences cardiac arrest or sudden cessation of breathing. CPR involves emergency measures such as external chest compressions, assisted or artificial ventilation, and the administration of emergency medications in an attempt to restore heart and lung function. Even when successful, CPR often requires prolonged hospitalization and intensive care and may result in significant additional cost.

Should my pet require resuscitation, my instructions are as follows: *

YES, Resuscitate as needed
NO, Do Not Resuscitate

**If you have chosen to resuscitate your pet, an IV catheter listed below is required and will be placed PRIOR to the start of surgery.

Recommended Optional Services

1. PRE-ANESTHETIC BLOOD WORK: $158.00 *

Accept
Decline

Results of these tests help determine your pet’s readiness for surgery. Many diseases show up on blood work prior to the animal showing any clinical signs. Depending on the results we are able to adjust anesthetic doses, implement the correct fluid therapy and/or delay surgery if needed. This information also provides us with a baseline of normal values we can use for comparison as your animal ages or gets sick in the future.

2. MICROCHIP PLACEMENT: $73.50 *

Accept
Decline

Thousands of animals a year are found in animal shelters and their owners are never identified. Having a permanent form of identification, like a microchip, can be a crucial tool in reuniting you with your pet.

3. IV CATHETER AND FLUID ADMINISTRATION: $67.00 (Included in canine spays, canine neuter, feline spay and canine/feline dental procedures) *

Accept
Decline

IV fluids do numerous things for the anesthetized patient. First, they keep the animal hydrated and provide blood pressure support during the procedure. It is common during anesthesia for blood pressure to drop and when that occurs there is a risk of damaging internal organs, therefore causing illness in the future. Having a catheter in place also allows for emergency access to administer lifesaving medications if needed. Fluids also help metabolize the anesthetic drugs more quickly, leading to faster recovery times.

4. HEARTWORM TEST (CANINE): $16 or FELINE LEUKEMIA/FIV TEST (FELINE) : $58.00 *

Accept
Decline

Heartworm testing and Feline Leukemia/FIV testing is recommended once a year

5. CAN WE UPDATE YOUR PET’S VACCINES TODAY? $29-100 *

Accept
Decline

6. E-COLLAR: Helps reduce licking of incision during healing period. *

Accept
Decline

7. ORAL SEDATIVE (CANINE): Helps keep patients calm during healing period. *

Accept
Decline

Same-Day Discharge vs. Overnight Hospitalization: *

SAME DAY DISCHARGE
OVERNIGHT STAY

Snake River Veterinary Center does not have staff on-site overnight; therefore, same-day discharge is available at owner’s discretion. Same-Day discharge allows close observation by the owner in a familiar home environment which may help reduce stress. However, same-day discharge places the responsibility on the owner to monitor the pet for changes and ensure the pet remains calm and confined. Pets discharged same day should be kept indoors in a temperature-controlled environment, ideally confined to a kennel or small space to limit activity. If you do not feel you can provide this for your pet, overnight hospitalization is offered at no additional cost.

Owner Signature: *

Clear Signature

Date: *

Surgical Release Form

How to Complete the Form