Are vaccinations current?
Is your pet on heartworm prevention?
Did your pet eat this morning?
Is your pet allergic to any drugs that you know of?
If so, please list them
Has your pet had any accident or illness in the last 30 days?
If so, please explain
Is your pet currently on medication?
If yes, please list
Any other specific problems to be checked?
Home Again Microchip identification $59.50
Hip Dysplasia Screening X-ray
Ear Cleaning $12.00
We strive to keep a pest free environment for your pet so we require that any internal parasites (worms) or external parasites (fleas and ticks) identified on your pet will be treated at owner's expense.
I authorize a Post Surgical Pain Injection at a cost of $22-43.00
I DoI Do Not
I request the ADDITIONAL PAIN MEDICATION at the time my pet is discharged from the hospital at a cost of $12-20.00. This is an additional pain medication to make my pet more comfortable at home for the next 24-72 hours after surgery.
I DoI Do Not
You are to take all reasonable precaution against injury, escape, or death of my pet. I understand that anesthesia and surgery always involves some risk to my pet (such as unknown internal physical abnormalities, medication allergies, surgical complications, internal bleeding, shock, incision dehiscence, and post surgical infections) and I agree to hold you harmless, in the absence of negligence, in connection with these procedures. I acknowledge that no guarantee or assurance has been made to me as to the results that may be obtained. In the event complications arise and I cannot be immediately contacted at the below listed phone number, you are directed to make the decision you deem fit best for my pet. I agree to pay for the services rendered.
I have read the foregoing, understand what it says, and agree.
Please go to Pre-Anesthesia Blood Screen Consent Form and fill out completely.