ARK VETERINARY HOSPITAL, INC.
AUTHORIZATION FOR PROFESSIONAL SERVICES
Date: ______Owner: ______Pet:______
Phone number where you can be reached today: ______Post Surgery Call ____
PROCEDURE (Check All that Apply)
_____ Spay (Ovariohysterectomy) - female
_____ Neuter - male
_____ Declaw cat - ____Front feet only ____All four feet
_____ Dental cleaning & polishing
_____ Perform any necessary dental procedures and extractions at this time.
_____ Call prior to performing these procedures.
If I cannot be reached it is okay/not okay to proceed.
_____ Tumor removal/Lumpectomy
_____ Dewclaw removal - dog
_____ Sedation/Anesthesia for diagnostics or treatment
_____ Pre-Surgical blood profile
_____ Other: ______
The nature of these services has been described to my satisfaction and I realize that no guarantee nor warranty can ethically or professionally be made regarding the results or cure.
I understand that anesthesia carries some risk (even though it may be small). To help further minimize that risk, a pre-surgical blood panel that screens organ function will be run on your pet before anesthesia. Most anesthetic agents are removed from the body by the liver and kidneys, so it is important to know before anesthesia that these organs are functioning properly. The pre-anesthetic blood profile helps us make this determination as well as helping to evaluate the overall health of your pet. If your pet has had such testing within the past thirty days with normal results, the test will not need to be repeated today.
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POST-OPERATIVE PAIN CONTROL
Every animal experiences pain from surgery to a different degree. The doctors and staff of the Ark Veterinary Hospital, Inc. strive to ensure the comfort of every pet in our care. Any pet undergoing a procedure which may cause discomfort will be given a pre-operative pain medication injection and will be discharged with medication to provide continued relief during the home recovery phase.
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MICROCHIPPING IDENTIFICATION is a simple and affordable procedure. Microchipped pets are much more likely to be returned to their homes should they become separated from you. While your pet is under sedation, would you like us to microchip him/her. Cost: $49.00
(There is also a one-time registration fee of $19.99 payable to Home Again)
_____ YES, Please Microchip my pet.
_____ NO, I do not wish to Microchip my pet at this time/my pet is already microchipped.
E-COLLAR - It is very important that your pet not lick it’s incision excessively. If you feel this may be
an issue for your pet, please let us know.
______YES, I feel an e-collar will be needed(charge per size).
______NO, I do not think it will be necessary, but will call if I notice any excessive licking.
Signature of owner or agent:______