Apple Valley Veterinary Clinic

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Owner’s Name
Pet’s Name
Acct #
Email
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Procedure
Last Time Pet Ate
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Pre-Anesthetic Blood Safety Screen – Our on-site laboratory allows us to screen for hidden problems before your pet’s treatment begins. These tests allow us to create an individualized anesthetic plan for your pet. If the results are within normal limits, we will proceed with confidence. If the results are not within normal ranges, we can alter the anesthetic procedure or take other precautions to safeguard your pet’s health.

*This bloodwork is performed on ALL of our patients prior to undergoing anesthesia*

Pain Management – Your pet’s comfort is important to us and we believe that the alleviation of pain expedites the healing process.

*Pain medication is prescribed for ALL of our surgery patients*

Laser Therapy – Laser therapy has shown to reduce pain and speeds the recovery process from surgery.

*Laser therapy is performed on our surgery patients prior to discharge*

IV Catheter & Fluids - During anesthesia your pet’s blood pressure can drop and this may damage the kidneys. By providing fluid therapy, your pet’s blood pressure will better stay in the normal range during anesthesia. In case of an emergency, the IV catheter also provides quick access for injections. If an IV catheter is unable to be placed, subcutaneous fluids will be administered.

*Fluid therapy is prescribed for all patients undergoing anesthesia*
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Dental ServicesShould previously undiagnosed dental procedures become necessary in the veterinarian’s professional judgement,
I prefer that you proceed with all necessary dental procedures including radiographs and extractions.
I prefer to be called prior to any additional procedures, other than emergencies. If I cannot be reached, I authorize the veterinarian to proceed with all necessary dental procedures and/or radiographs.
If I cannot be reached by phone, I do not authorize any unforeseen dental procedures.
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Home Again Microchip PlacementThe cost for the Home Again Microchip, implantation, and registration of the chip by the Apple Valley Veterinary Clinic staff is $55.
YES, please microchip my pet.
NO, I do not wish to microchip my pet at this time.
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Pedicure while under anesthesia – We offer a complimentary trim while your pet is under anesthesia.
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Estimation of feesWould you like an estimate of the procedure(s) that you are consenting to today?
Yes
No
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Authorization and Risk Assessment – I understand that during these procedures great care is taken to ensure my pet’s health, but unforeseen conditions may be revealed that necessitate the extension or variance in the procedure(s) defined above. I authorize Apple Valley Veterinary Clinic to perform any additional diagnostic, treatment, or surgical procedure(s) deemed necessary for medical or surgical complications or any unforeseen circumstances. While Apple Valley Veterinary Clinic provides the highest quality of anesthesia monitoring and surgical services, I understand the risks and understand that the veterinarians and hospital team will do everything possible to reduce any risks. I will not hold Apple Valley Veterinary Clinic, the veterinarians or any hospital team member liable for any complication that may arise.

In addition, if any external parasites are observed on your pet, he/she will receive treatment at your (the owner’s) expense.

I understand that all fees must be paid in full at the time your pet is released from the hospital.

By signing this document I certify that I have read this document, understand it, and agree to the conditions of treatment. My signature below authorizes the veterinarians at the Apple Valley Veterinary Clinic to preform said procedure(s)/treatments(s) described above.
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Owner/Agent’s Signature* This field is required.
Clear
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Date* This field is required.
Date
Year
Month
Day
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Phone number where I can be reached throughout the day
Should be Empty: