Pet Owner Information
Please enter a valid cell phone number. Unless otherwise specified, we will use this number as your emergency contact phone number AND the number we will contact you on after your pet's surgery is competed.
Would you like to use this as your emergency contact number?
Pet Information
Is your pet a dog or a cat?
Sex
Choose
For the safety and comfort of our patients, and for the peace of mind for our clients, we have a minimum set of requirements before, during and after anesthesia. We offer additional care above and beyond our minimum standards for those cases requiring more, as outlined below. All of the costs of this care will be fully outlined in the treatment plan before services are rendered. While we attempt to be accurate it does not include the cost of unforeseen circumstances and all efforts will be made to contact you if this occurs.
Standard Dental Requirements:

For safety and comfort, we require the following:

  • A current examination within 3 months unless needed sooner to surgery due to condition.
  • Blood test to determine underlying problems for all patients.
  • IV fluids for stabilization under anesthesia and support during recovery.
  • Medication will be given before and after the procedure that lessens the perception of pain.
  • Treatment on sight of fleas, flea dirt or ticks at owner’s expense.

We require the following vaccines to undergo anesthesia:

FOR DOGS: Rabies, DHLPP and Bordetella

FOR CATS: Rabies and FVRCP

I understand that if my pet is not current, they will be given necessary vaccines for his/her protection at my expense. I also understand that if my pet is found to have parasites, they will also be treated at my expense.
Additional Services
I would like a microchip placed during anesthesia.
I would like a heartworm test.
Additional vaccinations:
I would like my cat to be vaccinated for Feline Leukemia.
Additional surgical services available:
I would like my pet to receive a Pre-Surgical EKG to further decrease the risk associated with anesthesia at an additional cost.
For your convenience we offer the following additional services that are more comfortable if performed while under anesthesia:
Standard Dental Statement:
My pet is undergoing a dental cleaning today, and if during anesthesia the doctor determines that one or more teeth need to be extracted, please note that the cost of extractions can range from $13-$600. Do you authorize this?
I understand that by choosing no, I am going against medical advice:
If your pet becomes ill, we will call the emergency phone number you provide. If no one can be reached and medical attention is required do you authorize whatever services the doctor deems necessary
DO NOT administer any medical treatments, including life saving measures.
Please initial the following:
Initials
Initials
Initials
Initials
Sign above
After Surgery
We will call you when your pet’s surgery is completed. Please select if you would like a call or text and include the number where you would like to be notified.