If your pet is here for a spay procedure, please complete the following:
The Veterinarians at the Animal Medical Clinic recommend pre-anesthetic blood work for all patients undergoing anesthesia/
tranquilization. Pre-anesthetic blood work is required for all animals 8 years of age and older The blood work will assess for any contraindication to performing the procedure at this time; i.e. liver, kidney or other underlying dysfunction. The approximate cost for blood work can range from $50-$150. If blood work has been obtained within 30 days prior to the procedure and was within normal limits, the
veterinarian may agree to waive pre-anesthetic blood work.
Medication Information: (Please List)
Walk-in/Drop Off (Admissions) may be required to leave a minimum 20% deposit of estimated costs of procedures. All remaining charges/balances shall be paid in full upon discharge from the hospital. WE DO NOT ACCEPT CHECKS. We do not bill.
**Large cash bills only accepted under certain circumstances. **
~WE ACCEPT CASH, DEBIT, CREDIT CARDS, VISA, MASTER CARD, AMERICAN EXPRESS, DISCOVER AND CARE CREDIT
If you do not currently have Care Credit and would like to apply. Please go to our website > Resources tab > Payment Options to apply
All reasonable precautions will be taken against injury, escape, or death of hospitalized patients. The Animal Medical Clinic, its staff and/or veterinarians, will not be held liable or responsible in any manner in connection there with as it is thoroughly understood that I assume all risks. I also understand that the Animal Medical Clinic is not staffed 24 hours a day and may warrant transfer to a 24-hour facility at the discretion of the veterinarian.
CONSENT FOR SURGERY/TREATMENT: I, being responsible for the above animal/animals, have the authority to grant the ANIMAL MEDICAL CLINIC my consent to receive, prescribe for, treat, and/or operate upon my pet. I understand that any quoted fees are “estimates” only and individual treatments and/or surgical procedures may require more time and/or surgical materials at additional costs. I understand and agree to the following surgery and or treatment plans and agree to pay all costs incurred for any and all professional services. I further understand that if further treatment is required, I will be contacted for verbal authorization of treatment and additional cost prior to administration of further treatment.
After reading the above, I have signed in agreement below
Authorization for professional services (must be over age 18):
Please read the following surgical release form carefully. By signing at the end of this form, you are agreeing that you have read and understand the terms and conditions for your pet to be under the care of Animal Medical Clinic surgeons.
General Anesthetic Risks: Although every effort is made to ensure anesthesia is as safe as possible, there are inherent anesthetic risks to your pet. The incidence of complications from anesthesia are extremely low and we do not anticipate any in your pet, but, on rare occasions the following may occur:
1. Allergic reaction to the anesthetic agents.
2. Heart rhythm abnormalities.
3. Untoward reactions to gas anesthesia including drops in blood pressure or respiratory difficulties.
4. On very rare occasions, general anesthesia can result in death due to unforeseen cause.
Our trained veterinary medical team will take every precaution to take care of your pet while in our care. We monitor your pet’s vital signs diligently and utilize only the most up-to-date anesthetic agents and equipment.
Surgical Consent to Medical Treatment and CPR Directive: In the unlikely event that your pet will require resuscitative measures, please read the following directive, and choose one of the options for cardiopulmonary resuscitation (CPR).
During anesthesia, life threatening complications such as respiratory and/or cardiac arrest may occur, requiring medication treatment and/or CPR. If my pet stops breathing or his/her heart stops beating, I realize even the most successful CPR measures may not restore him/her to good mental and physical health.
Endotracheal tube intubation (if not already utilized), positive pressure respiration, administration of emergency drugs, external cardiac massage (chest compressions)