Surgery Release Form Cat's Name*Client's Name*Please provide the phone number we should use to contact you todayFood Brand*Type*CannedDryBothHow often is cat fed, and how much?*Reason for visit*Additional services requested (please ask for estimate)Has your cat ever become ill following vaccines?*YesNoIs your cat on flea or heartworm prevention?*YesNoIf so, what type*RevolutionAdvantageCheristinComfortisWas flea prevention applied within the last 30 days?YesNoWas flea prevention applied within the last 30 days?YesNoWhen did your cat last eat?*If your cat is undergoing anesthesia/sedation, it is VITAL that we know if he/she has eaten today to prevent life-threatening complications. If medication is necessary, which do you prefer?*PillLiquidEitherBuprenorphine SR (3 day lasting pain injection: if needed)Dentistry OnlyExtractions cost $35-$110 per tooth (including dental x-rays). Do you request a phone call before we perform extractions?No - Proceed with extractionsYes, contact meIf you choose yes, we will make a single call to the number you indicated above. If you do not answer, we will proceed with any necessary extractions. AcknowledgementCertain surgeries and dentistries require an overnight stay. Pets are unsupervised overnight. If you wish to have your pet supervised overnight at the emergency hospital, please let a nurse or doctor know. I, the undersigned owner or authorized agent, hereby consent and authorize All Cats Hospital, LLC, its veterinarians and agents to receive, prescribe for, board, or operate upon my cat. I understand that no guarantee has been made except reasonable precautions against injury, escape, or illness. I authorize All Cats Hospital, LLC to remove my cat(s) from the premises if weather or building conditions warrant it best for him. If someone other than yourself will be picking up, please indicateName of Owner or Agent*Signature of Owner or Agent*
