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Surgical/ Anesthesia Release Form

Save time during your next appointment! Complete your required surgical/anesthesia release form online from any device at any time before your visit.

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Surgical/Anesthesia Release Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. You can also download the form by clicking the button below.

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1. Pre-anesthetic blood testing: like you, our greatest concern is the well-being of your pet. Performing blood tests can help ensure a safer anesthetic procedure for older pets and can help detect some health problems before they become serious. RECOMMENDED for all pets. REQUIRED for pets seven years or older, and in specific cases identified by your veterinarian. *

YES, I want my pet to have pre-anesthetic blood testing. This is an additional fee.
NO, I do not want a pre-anesthetic blood test for my pet.

2. Datamar Microchip: We recommend Datamars Microchip. It is convenient for you and painless for your pet when implanted while your pet is anesthetized for surgery. *

YES, I want my pet to have a Datamors Microchip
NO, I do not want a Datamars Microchip.

3. Additional medical care I would like for my pet:

Vaccines updated
Parasite screen (stool sample)
Check and clean ears
Anal glands
Heartworm test: (For the safety of your pet, we REQUIRE ALL DOGS to be up to date on yearly heartworm testing before undergoing anesthesia. This is an additional fee.)
Feline Leukemia blood test
Lumps, bumps, growth

Nail trims are a courtesy valued by clients and patients during a surgical procedure.

Lumps, bumps, growth: Location *

4. Flea Prevention:

For the health of all pets that visit our hospital, if your pet is found to have fleas while at our clinic for surgery or treatment, a Capstar will be administered.

5. All procedures involve some risk. We have provided many risk-reducing factors specific to the procedure, such as diagnostic blood testing, IV catheter with fluids, high-tech monitoring equipment, and a dedicated anesthetist. In the rare and unforeseen event of a life-threatening emergency, I understand that Mayfair Animal Hospital will initiate emergency measures and attempt to contact me immediately. I understand this may generate associated fees and that I will be responsible for these fees. *

I accept
Declined

Emergency Measures:

6. I authorize Mayfair Animal Hospital and its staff to sedate my pet and perform the procedures I have requested. I understand that while the anesthetic used in the hospital is one of the safest used in Veterinary medicine, no surgery is without medical risk. No guarantee can be made legally or ethical to me regarding the outcome of any procedure. *

I agree

Pet’s Name *

Owner’s Name *

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Last

Telephone number(s) where we can reach you today *

Cell

Email *

Name *

Date *

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At Mayfair Animal Hospital, we take veterinary medicine to the next level without sacrificing the family feel vital to quality patient care. With our team of dedicated professionals, state-of-the-art facilities, and personalized services, we strive to provide exceptional veterinary care. Please request an appointment for your pet using our online system on PetDesk, and keep up with your pet’s health by downloading our app. We proudly serve the pets of Clio, Flint, Birch Run, Mt. Morris, and beyond.
We look forward to seeing you and your pet! Request an appointment by clicking the button below.

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Questions?

Get in touch! We look forward to hearing from you.

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Location

8025 N. Clio Rd.
Mt. Morris, MI 48458

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Contact Information

P: 810-785-0111
F: 810-787-6939
E: mah@mayfairvetflint.com

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Hours

Mon-Fri: 8 am – 5 pm
Sat-Sun: Closed

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