Apple Valley Animal Hospital

1207 cedar creek grade Winchester, Va 22602
winchester, VA 22602

(540)667-0260

www.applevalleypet.com

Surgery Consent Form

Date (required) :
Pet (required)

Surgery (required)


I hereby authorize the veterinarians of the Apple Valley Animal Hospital to perform the below procedures and any additional diagnostic and/or treatment procedures as deemed advisable or necessary for my pet. I understand that any additional procedures may increase the final cost. I understand that the hospital requires that all pets have a recent physical examination, be free of all parasites, and be current on vaccinations. I realize that there is always risk when anesthetics and other medications are used and when surgery is performed. I understand that results cannot be guaranteed. The Apple Valley Animal Hospital has business and medical staffing hours: Monday 7am- 6pm Tuesday through Friday 8am-6pm, and Saturdays 8am - 1pm. The hospital is closed and not staffed at all other hours. The doctors make rounds at night as needed.
Has your pet had anything to eat in the last 8 hours? (required)

Yes
No


Where can we reach you today? (required)
Phone TypePhone Number (required)
E-Mail Address (required) :
Owners County (required)

Payment is due when pet is picked up from surgery. Do you understand and agree? (required)

Yes
No


If the doctor finds something unexpected I would like the following steps taken: (required)

Do not perform any extra services to my pet.
You do not need to call me, do what is best for my pet within (put amount below)
Call me before performing any other services (put number below).


Price range if selected above (NA if not applicable) (required)

Number to be reached if selected above (required)
Phone TypePhone Number (required)
If I cannot be reached: (required)

Microchipping is recommended in all pets. The procedure is more comfortable while you pet is under anesthesia
The fee below includes insertion of the microchip and registration with HomeAgain Pet Service. MicroChip ID and Registration - $52.00 (required)

Yes
No


Pre-Anesthetic Blood Testing and Healthy Heart Check
Our greatest concern is the well-being of your pet. Before putting your pet under anesthesia, we can perform a blood analysis. This gives us an inside look at your pet’s vital organs and lets us know if they are functioning normally. Such tests are important before any kind of surgery. We strongly recommend that you have the blood work done at any age, but if your pet is over six years old we do require a MINI chemistry panel be performed. If your pet is over eight years old we do require the full blood PROFILE to be done. We can also check your pet’s heart by the use of an ECG. This will insure us that your pet has a strong and healthy heart before going into surgery. Ask for the lab’s current prices.
I would like the MINI panel done for my pet’s safety (6 chemistry panel-PCV-Total protein)
I would like the FULL PROFILE done for my pet’s safety (12 chemistry panel -PCV-Total protein-CBC)
I would like an ECG done on my pet to insure a healthy heart before surgery is done today.

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