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Owner(Required)

Pet(Required)

Procedure(Required)

Phone number today(Required)

I hereby authorize The Roscommon Veterinary Clinic, to perform the above procedure(s). In addition, I understand that during the performance of the procedure, unforeseen conditions may arise that necessitate an extension or variance in the procedure(s) set forth above. I am aware that unforeseen events arising from the procedure(s) will not relieve me from any obligations to all reasonable costs incurred regarding the animal. I have been advised as to the nature of the procedure or operations, and the risks involved.

We require all dogs to be current on vaccinations for Distemper, Parvovirus, Leptospirosis, and Rabies when hospitalized. (If your pet is found to have live fleas at the time of admittance we will be treating for fleas at your expense.)

Please select a choice at each option.

Please protect and identify my pet with a Microchip:(Required)

Yes

Vaccinate my dog for:

Rabies(Required)

Yes

Current

Dhpp(Required)

Yes

Current

Lepto(Required)

Yes

Current

Bordetella(Required)

Yes

Current

I want my pet to receive:

Intestinal Parasite Exam (Fecal)(Required)

Yes

Heartworm and Tick Illness Test(Required)

Yes

We strongly recommend pre-anesthetic blood testing before any procedure as it can identify increased risks for complications. Please rest assured that advances in anesthesia and surgery have made procedures relatively safe with a low rate of complications. Nevertheless, occasional problems can arise due to pre-existing conditions not evident during routine examinations.

An IV catheter and fluids are also strongly recommended to maintain your pet’s blood pressure and decrease the risks of complications due to low blood pressure during procedure, to prevent dehydration, to aid in recovery, and to protect a life-line in the event of an emergency.

We require pre-anesthesia blood testing and I.V. fluid therapy on all pets 7 years of age and older to better identify and reduce the increased anesthetic risks in middle to older aged pets.

We require I.V. Fluid therapy on all patients here for dentistry for additional support due to the length of procedures.

I accept Pre-anesthetic blood testing(Required)

Yes

I accept Fluid therapy(Required)

Yes

Please list all medications that the pet is currently taking.(Required)

I have read and understand this authorization and consent form and agree to pay services in full at the time my pet is discharged, unless previous arrangements have been made with the office manager. If you have any questions or concerns, a veterinarian or veterinarian technician will be glad to address them with you.

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