Pre-Op Authorization Form Owner's Name * Pet's Name * Procedure * Please read carefully and digitally signYour pet is with us today for a procedure that will require anesthesia. We will perform a fully physical examination on your pet before administering the anesthesia. In addition, we will perform a pre-anesthetic blood profile. This allows us to assess kidney and liver function as well as blood sugar levels which can help detect diabetes. We can also detect anemia or clotting disorders.If your pet is having a Dental Cleaning: Not Applicable / My pet is not having a dental cleaning.I hereby authorize any extractions that may be necessary during my pet’s dental procedure. I understand there is an additional cost for extractions, depending on severity.I would prefer to be notified during my pet’s dental procedure of extractions needing to be performed. I understand this means my pet will be under anesthesia for an extended time.While under anesthesia, here are some additional procedures to consider.Please select which procedures you wish to receiveNail trim - $21.00Microchip Implant - $44.50 (ask us about it!)Ear Cleaning - Varies with severityBath, Nails, & Anal Glands (price depends on size)Express Anal Glands - $25.70Yes, I understand the risks of both anesthesia and surgery. To reduce the risk, I understand that a pre-operative blood profile will be run to assess organ function. I also understand that my pet will be sent home with pain medication to be given at home.Digital Signature * Date * Phone number where you can be reached today *