Surgery Consent Form Please fill either the canine or feline surgery form and fill in as completely and accurately as possible. Get Started Canine Surgery FormFeline Surgery Form Please enable JavaScript in your browser to complete this form.Owner Name *FirstLastPhone *Email *Pet Name *FirstLastSex *MaleFemaleAge Selected Value: 0 Date of Surgery *Procedure *VaccinesRabiesDhlppLymeKennel CoughCurrentRabies vaccination must be current or updated at time of surgery.The Heartworm/Tick Test is required before undergoing surgery (unless it is current within the last 6 months) It detects blood infections from tick diseases or heartworm disease which can be an anesthesia complication.$70.00 initialCurrent as ofDate *If your pet is on any medications, when was the last dose and what medicationIf external parasites - fleas or ticks are detected upon exam today, treatment products will be applied at additional charges. Has your pet been treated at home? What product and whenFor Female Dogs - When was the last heat cycle? If she is found to be pregnant, Do you authorize termination of pregnancy at additional charges.Please check off the recommendations you would like at additional chargesPre-Surgical Blood Analysis/CBC - This is to ensure vital organs are functioning in a healthy and normal manner before administering anesthesia. $118.00IV Catheterization: This is performed prior to surgery; provides immediate access to administer fluid therapy and/or emergency drugs, should the need arise. $43.00Home Again Microchipping: $62.00 Already Microchipped? If yes, we can scan your pet to confirm the numberE-Collar: Prevents your pet from Licking or chewing at the surgery site, especially in adult pets.$16.50I have been advised of the nature of the services and procedures to be performed. I understand that there is always risk associated with any anesthesia episode, even in apparently healthy animals. As the owner or agent of the animal named above, I hereby give my consent to Grantsburg Animal Hospital/Wild River Veterinary Clinic to perform the following procedures and or treatments. I realize that I am responsible for payment in full at the time of discharge. *Clear SignatureSignatureSubmit Please enable JavaScript in your browser to complete this form.Owner Name *FirstLastPhone *Email *Pet Name *FirstLastSex *MaleFemaleAge Selected Value: 0 Date of Surgery *Procedure *VaccinesRabiesRcpRcp/ FeLeukFeLeukCurrentRabies vaccination must be current or updated at time of surgery.If your pet is on any medications, when was the last dose and what medicationIf external parasites - fleas or ticks are detected upon exam today, treatment products will be applied at additional charges. Has your pet been treated at home? What product and whenIf your pet is to be spayed and is found to be pregnant, Do you authorize termination of pregnancy at additional chargesPlease check off the recommendations you would like at additional chargesFeline Leukemia/Feline Immuno-Virus/Heartworm Test - This tests for those viruses & heartworm infection $63.00Pre-Surgical Blood Analysis/CBC - This is to ensure vital organs are functioning in a healthy and normal manner before administering anesthesia. $118.00IV Catheterization -This is performed prior to surgery; provides immediate access to administer fluid therapy and/or emergency drugs, should the need arise. $43.00Home Again Microchipping - $62.00 Already Microchipped? If yes, we can scan your pet to confirm the numberE-Collar - Prevents your pet from licking or chewing at the surgery site. $16.50DeWormer - Would you like us to get a treatment of intestinal parasite control ready for you? Price depends on Doctors pre surgical exam & treatment.Fecal Lab Exam - Laboratory Test for intestinal parasites $49.00I have been advised of the nature of the services and procedures to be performed. I understand that there is always risk associated with any anesthesia episode, even in apparently healthy animals. As the owner or agent of the animal named above, I hereby give my consent to Grantsburg Animal Hospital/Wild River Veterinary Clinic to perform the following procedures and or treatments. I realize that I am responsible for payment in full at the time of discharge. *Clear SignatureSignatureSubmit
