Hospitalization Form

Owner

Phone

Email

Patient Name

Service:

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I certify that I own the above-described pet, and I do hereby consent and authorize Lenoir City Animal Clinic and staff to hospitalize this animal, and to administer medications, tests, surgical procedures, anesthetics, and/or treatments that the doctors deem necessary for the health and well-being of the above pet while he/she is under their care and supervision. I do hereby release Lenoir City Animal Clinic and staff of any responsibility and/or liability, in the absence of gross negligence, in the event this pet should injure itself, refuses food, become ill, or die while in the hospital.

I further realize that I am responsible for payment in full for procedures and treatments listed above at the time of discharge. If I neglect to pick up my pet within 5 days of written notice, you may assume that the pet is abandoned. Abandonment does not release me of my obligation for the bill.

Pets over 7 years old will require bloodwork within 6 months. Bloodwork is recommended within 6 months for pets under 7 years old but required within 12 months. Heartworm test will be required for dogs of any age having a procedure. All surgery pets must have had an exam within 6 months.

If pre-anesthetic bloodwork has not been performed before surgery, it will be done today in our office preoperatively at a cost of $210.58 This blood screen consists of 21 blood chemistries, electrolytes , & CBC.

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Yes

Advances in Laser technology and its adaptation to veterinary medicine now allow us to offer LASER SURGERY to our patients. I UNDERSTAND THAT LASER SURGERY IS AN OPTION AND REQUIRES AN EXTRA FEE OF $104.36

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Yes

PROCEDURES REQUIRING GENERAL ANESTHESIA WILL REQUIRE IV CATHETER PLACEMENT.

For pets being spayed/neutered today, a tattoo indicating such surgery will be placed near the surgery site at no additional cost.

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I consent

I decline

Therapeutic Cold Laser - Postoperative laser therapy can decrease inflammation and pain after surgery, aid in the healing process, and hasten recovery time.

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Yes, please perform a laser treatment $29.85

No, I decline

In the event of an emergency and I can not be reached, I authorize Lenoir City Animal Clinic to perform CPR on my pet.

Hospitalization Form

Owner

Phone

Email

Patient Name

Service:

Signature

Date

Emergency Phone Number