Form - Surgery/Anesthesia Form

Date of Procedure (required)

Procedure to be performed (required)

Acknowledgement (required)


Pre-Anesthetic Lab Work:
Pre-anesthetic lab work is highly recommended, but not required. This is important to minimize anesthetic complications in pets of all ages. Although routine procedures are relatively safe, occasional problems may arise due to re-existing conditions that would not be evident during a routine pre-surgical examination. Labwork will aid the safety of the anesthesia. These results will also serve as a baseline of what is normal for your pet to use for future comparisions.
(required)
a - I do want the lab work (Pediatric and Adult - $52)
b - I do NOT want the lab work (Pediatric and Adult)
c - I do want the lab work (Geriatric $74.50)
d - I do NOT want the lab work (Geriatric)

Post-Surgical Pain Medication:
We recommend medication for pain management after any invasive procedure. Less pain promotes a faster recovery. The cose ranges from $12-$50.
(required)
a - I do want the medication if deemed necessary for the procedure
b - I do NOT want the medication

Homeagain Microchip Placement:
A sterile microchip is implanted under the skin between the shoulder blades. It contains a code which can be scanned by veterinarians, SPCA, or animal control officers if your pet is lost or stolen. Cost - $56 including registration fees for the first year with Homeagain.
(required)
a - I do want the microchip
b - I do NOT want the microchip

Dental Radiographs:
If your pet is receiving a dental prophy, dental x-rays can be performed at your doctor's direction. Cost varies according to the number of views.
(required)
a - I do want dental x-rays if deemed necessary by the doctor.
b - I do NOT want dental x-rays
c - Please contact me before proceeding. If I cannot be contacted with the first attempt, NO x-rays will be performed.

Porphyromonas Vaccine:
This is a dental health vaccine to help prevent future infections. The cost of the vaccine is $33.50. If this is an initial vaccination, a booster will be needed in one month at an additional fee of $33.50.
(required)
a - I do want the vaccination
b - I do NOT want the vaccination
Retained deciduous teeth or extraction of diseased teeth:
If your pet has any retained deciduous "baby" teeth, they should be extracted. If your pet is receiving a dental prophy, there may de some teeth that are disease and need to be extracted.
Please choose one: (required)
a- I do want decidious teeth removed.
b- I do NOT want decidious teeth removed.

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