Surgical Release Form Surgical Release Form Your Full Name*Your Pet's Name*Other persons authorized to drop off or pick up your pet:The best phone number to contact while your pet is at LVVS:*A secondary contact number:Is your pet currently taking any medications? Please list medication with dose and frequency, including any preventative flea/tick/heartworm medications.*Are we running pre-anesthetic bloodwork for your pet?* Yes, my pet is 7+ years old Yes, my pet is under 7 years old No - My pet is under 7 years old and I would not like additional risk assessment at this time.Bloodwork is a good tool to assess risk in patients before undergoing a procedure under anesthesia. It is required for patients age 7 or older, and recommended for all patients. Pre-anesthetic bloodwork is offered at a discount because we believe in it's importance. It costs roughly $150.Would you like us to run an illness screening on your pet?* Yes, Canine, for $51.50 ($12.50 discount with pre-anesthetic bloodwork). Yes, Feline, for $62.50 ($12.50 discount with pre-anesthetic bloodwork) No, not at this time.For dogs, we test for Lyme disease, Anaplasma, Erlichia, and Heart Worms. For cats, we test for Feline Leukemia, Feline Immunodeficiency Virus, and Heart Worms. These tests are also a tool for risk assessment and can catch serious illnesses in patients.Is your pet up to date on vaccines?* Yes NoWe require patients to be current on rabies vaccination at a minimum. If they are not, we will administer the vaccine the day of the procedure for $15. If your pet has received vaccinations elsewhere, please send us their records before the day of their procedure.If not, what vaccines would you like your pet to receive while they are here? Rabies, Canine ($15) DHPP (Distemper Combo), Canine ($23) Leptospirosis, Canine ($21) Bordetella (Kennel Cough), Canine ($21) Lyme Disease, Canine ($30) Bivalent Influenza, Canine ($39) Rabies, Feline IMRAB ($15) Rabies, Feline PureVax ($25) FVRCP Feline Combo ($23) Feline Leukemia ($29)Does your pet have a microchip?* Yes No, but I would like one ($25) No, and I would not like oneMicrochips are small, passive identification chips. They can be read by any veterinary facility or shelter, and link to your information. They are an invaluable tool in the event of a pet being lost and returned to you.If your pet displays anxiety to a concerning degree while they are in the hospital, what would you like us to do?* Administer anti-anxiety medication to my pet Call me to make a plan for my pet, which may mean rescheduling the procedure.Would you like any additional services for your pet while here?We will do our best to accommodate requests. All patients receive a nail trim while sedated. Patients being spayed or neutered will receive the standard small green tattoo near their incision site.