Surgery & Anesthesia Release Form
Marina Vet Mobile
Dr. Rachel Jones CVCP
Client's Name *
Pet's Name *
Contact number during procedure *
Please confirm & acknowledge the procedure that your pet will be having:

I understand that for the best interest of my pet that an IV catheter will be placed causing a small area of fur to be clipped on the front leg.  I authorize Marina Vet Mobile to perform surgery on my pet.  I understand that there is always a risk involved with anesthesia and surgery.  Furthermore I authorize the doctor and staff in an emergency situation to use their best judgement in the best interest of my pet.  This may involve cancelling the surgery if any complications arise and I am aware that I would still be financially responsible for the anesthesia and any initial procedures that have been started.  Should any emergency occur I authorize my pet to be resuscitated and assume all costs ranging from $100-200.

 By checking the box below I authorize and consent to the above procedure.

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