865-777-1221 info@lovellvet.com

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Surgery Release Form

Thank you for your interest in our clinic for your pet’s needs. Please complete our Surgery Release Form.

Client's Name *

First

Last

Email *

Layout

Patient's Name

Breed

Emergency Contact Phone *

Species

Canine
Feline

Sex

Male
Female

I am the owner or agent for the above described pet and have authority to execute this consent. I hereby consent and authorize the performance of the following procedure(s) or operations(s): *

I understand that during the performance of the foregoing procedure(s), unforeseen conditions may be revealed that necessitate an extension of the foregoing procedures(s) or operations(s) or different procedure(s) or operations(s) than those set forth above. Therefore, I hereby consent to and authorize the performance of such procedure(s) or operation(s) as are necessary and desirable in the exercise of the veterinarian's professional judgment.
If a dental is performed, extractions are only done, if a tooth cannot be salvaged otherwise.
I also authorize the use of appropriate anesthetics, and other medications, and I understand that hospital support personnel will be employed as deemed necessary by the veterinarians.
I have been advised as to the nature of the procedure(s) or operation(s) and the inherent risks involved with anesthesia. I realize that results cannot be guaranteed.

I understand that in order to add to the safety of anesthesia to my pet, a pre anesthetic health profile should be performed prior to surgery under anesthesia. If i should utilize these safeguards, i realize that it will increase my bill accordingly as seen below: (please initial.) *

In addition, pain medication may be prescribed by the veterinarian to manage your pet's condition at home.

Pre anesthetic blood profile

I give my permission for a Pre Anesthetic Blood Profile. (Recommended for pets 8 years of age and older)—$71.50
I decline the Pre Anesthetic Blood Profile

Microchip insertion

I would like the Microchip insertion—$54.00
I decline the Microchip Insertion

Puppy or kitten - teeth

I give my permission to remove any retained baby teeth at a charge of $19.00 per tooth.
I decline to remove any retained baby teeth.

IV Fluids

If the doctor deems it necessary, I give my permission for IV fluids to be administered—$73.50

I would like pain medication for my pet post surgery.

Yes
No

Would you prefer liquid or pill for go home medication?

Liquid
Pill

I would like a histopath sent to us for an additional $196.00

Yes
No

I have read and understand this authorization and consent.

Signature

Comment

We Love Our Clients and Patients!

We appreciate your help in making Lovell Animal Hospital one of the best-rated veterinary hospitals. Your nice words mean the world to us, and we appreciate you taking the time to let us know what you thought.

We are constantly looking for new ways to improve our offerings because we want our customers to feel valued and appreciated.

Read More Reviews

Very caring to both the animals and humans they serve. Dr. Melskog has seen our past 2 dogs as well as my brother’s pets.

Jim Edward

Dr. Sherri and the staff have provided compassionate care for my older pup. They always give me complete information and treatment options.

Nancy Holder

PetDesk

Our PetDesk is designed to provide extended care for our patients and clients. You can request appointments, view your pet’s upcoming services and vaccinations, one-touch call and email, and more!

Purina Vet Direct

Materials posted here are for educational purposes only. Lovell Animal Hospital does not provide veterinary medical services or advice over the internet. Please consult your veterinarian in matters regarding your pet.

Our Appointment Policy

Out of respect for the staff and clients, we ask for a 24-hour cancellation notice. After two missed appointments without a 24-hour notice, the client may be subject to a fee.

Have a Question?

Please fill out the form below and a member of our team will get back to you shortly!

Name *

First

Last

Email *

Phone

How can we help you? *

Email

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Location

1305 Lovell Rd.
Knoxville, TN 37932

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Contact Info

865-777-1221
info@lovellvet.com

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Hospital Hours

Monday: 7:30 am–5:30 pm
Tuesday: 7:30 am–5:30 pm
Wednesday: 7:30 am–12 pm
Thursday: 7:30 am–5:30 pm
Friday: 7:30 am–5:30 pm
Saturday: 8 am–12 pm
Sunday: Closed

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