Canine Consent Form

Pet Owner Name
Pet Name
I am the owner or agent for the owner of the above described animal and have the authority to execute this consent.(Required)
Before putting your pet under anesthesia a physical exam will be performed. As part of the pre-surgical examination we offer a pre-anesthetic blood panel. These tests are similar to those your own physician would run if you were to under go anesthesia. These tests may be useful in diagnosing liver/ kidney disease, diabetes or other conditions that could complicate a surgical procedure.
Fee varies by weight of patient
Fee varies by weight of patient
If negative, would you like Heartworm medication sent home(test is good for 1 month without medication)
911 PetChip & Lifetime Registration(Required)
Fee varies by weight of patient
If your pet is scheduled for a dental cleaning, a licensed technician or veterinarian may perform the procedure. Extractions may be a necessary part of the dental procedure. If you mark yes for extraction a veterinarian will extract the necessary teeth. Diseased teeth can be a source for re-infection.
If we are removing a growth would you like it sent in the pathologist for identification.
May we text you at this number for an update on your pet?
Antibiotics, Asprin, etc.
I will allow an intern to perform the above procedure/surgery under the direct guidance of one of our veterinarians.(Required)
E-collar ($10.00-$30.00)