Surgical and Anesthetic Release form

Please initial your choices of treatment today:

FELV (Test for feline leukemia)


Ear mite treatment (Treated only if ear mites are found)


Feline Leukemia Vaccine


5-way Vaccine






Praziquantel(De-wormer for tapeworms)

$16.00 - $25.00



We HIGHLY recommend the following Pre-Anesthetic Blood Work:

“Mini Panel” - ($94.40) “PCV/TP” - ($46.20)
These tests check for abnormalities in kidney function, blood sugar, liver function, and protein. Abnormalities can greatly increase your pet's anesthetic risk.

“Full Wellness Panel” (Diagnostic Health Panel, CBC, T4) - ($306.95)
Covers all of the “Mini Panel” plus liver, thyroid, red and white blood cells and pancreas functions.

Cardiac Screen (ECG) (Cardio Pet Telemedicine) ($58)
Screens for early signs of heart disease.

I.V. fluid support will be required on all pets 3 years and older. The fee for this service will be $45.00. In addition, an e- collar and/or pain medication may be required. An additional $45.00 may be charged if your cat is pregnant or in heat

DNR- “Do Not Resuscitate” In case of an arrest, no cardiopulmonary resuscitation will be performed.

CPCR- “Cardiopulmonary Cerebral Resuscitation” Depending on the medications and procedures or treatments required, costs for CPCR could add $150 to $550 or even more to your current costs.

I understand that while the anesthetic used in the hospital is one of the safest in Veterinary medicine, NO anesthesia is without medical risks. No guarantee can be made legally or ethically on the outcome of any procedure performed.

Our hospital is NOT staffed 24 hours per day