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General Drop Off Form

Pet Name:

Date:

Procedure(s):

Procedure(s):

Has your pet eaten in the last 8 hours?

Has your pet eaten in the last 8 hours?
A
B

If yes, when? How much?

**What is your estimate?

All Surgical Procedures Include: Pre-surgical exam, and Post-surgical supervision. Pain management and antibiotics will be dispensed as needed.
For the health of your pet, we strongly recommend Pre-Anestetic Blood Testing which tests. for hidden problems such as clotting disorders, liver and kidney abnormalities, anemia, etc. If abnormalities are found we will NOT proceed with surgery and you will be contacted. Declining this bloodwork may put your pet at a higher risk during surgery.
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A
B
C
I have read and understand the benefits of pre-surgery bloodwork and the risks of declining.***
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A

Teeth: The doctor may discover your pet's teeth need cleaning, or that a tooth has a fracture, has abscessed or baby teeth that may need to be extracted.

Please checkmark all that apply:
Teeth: The doctor may discover your pet's teeth need cleaning, or that a tooth has a fracture, has abscessed or baby teeth that may need to be extracted.

Growths: If you've noticed a growth or lump and want it removed.

Growths: If you've noticed a growth or lump and want it removed.

Location:

Histopathology: This helps to identify the type of growth and determine if it is cancerous.

Histopathology: This helps to identify the type of growth and determine if it is cancerous.

Implant Microchip?

Implant Microchip?
A
B

Sterilization Tattoo?

Sterilization Tattoo?
A
B

E-collar to go home?

E-collar to go home?
A
B

Vaccines:

Vaccines:
A
B
C
Dog:
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Cat:
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Vaccines/Testing to be done by

Vaccines/Testing to be done by
A
B
Technician can ONLY do fecal, heartworm, and bloodwork testing and can ONLY administer the bordetella and flu vaccines.Pet MUST have been seen by doctor within past 6 months).

Additional Services Needed (ie nail trim, preventative)?

Additional Services Needed (ie nail trim, preventative)?
A
B
I realize that results cannot be guaranteed. I also understand that anesthetic agents and surgical procedures carry a small but realistic possibility of side effects including DEATH. I give my consent for the doctor to perform any procedures necessary for my pet's health should unforeseen conditions arise. Charges for services rendered and medicine/supplies delivered are due upon receipt of the invoice. Payment can be made by cash, check, credit card, or care credit.

Signature:

Signature

Call First:

Call Second:

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A