Apple Valley Animal Hospital

1207 Cedar Creek Grade
Winchester, VA 22602

(540)678-0202

www.applevalleypet.com

 

Surgery Consent

 

Please forward all previous records to avahpets@gmail.com 

 

During your pet’s surgery, we can remove some of their fat and send it to Ardent Animal Health where they will process the fat to remove your pet’s stem cells.  They will then keep those cells ‘frozen’ for the lifetime of your pet.  In the future, if an unexpected injury occurs, or when normal changes happen with age (such as arthristis) your pet will have access to the most advanced (and natural) care available.

Fat retrieval charge and overnight shipping  $243.00

Processing and a lifetime of banking (Paid to Ardent)  $695.00

Visit their website for more info at ardentanimalhealth.com

  

 

Surgery Consent Form

Would you like for us to collect stem cells during surgery? (see above for more information) (required)

Yes, please retrieve some of my pet’s extra fat for processing
No thank you


Date (required) :
Pet (required)

Surgery (required)


I hereby authorize the veterinarians of the Apple Valley Animal Hospital to perform the above procedure(s) 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 medical staffing: Monday through Thursday 8am-6pm, Fridays 8am-5pm and Saturdays 8am-2pm. If the doctor feels it is necessary, you will be asked to take your pet to the Veterinary Emergency Center for overnight care.
Owner's Initials: (required)

I am aware that pre-surgery blood work is recommended for the safety of my pet today.
Owner's Initials: (required)

Please select from the following regarding blood work:

Small Panel
Large Panel
None


My pet has had nothing to eat in the last 8 hours.
Owner's Initials: (required)

Where can we reach you today? (required)

Payment is due when pet is picked up from surgery.
Owner’s Initials: (required)

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 the amount indicated below
Call me before performing any other services


If the doctor finds something unexpected, do what is best for my pet within the following amount:

Microchipping is recommended in all pets. The procedure is more comfortable while you pet is asleep. The fee of $56.00 includes insertion of the microchip and the first year’s registration fee with HomeAgain (required)

YES, please protect my pet by microchipping today
NO thank you


Owner's Name: (required)
First Name (required)
Last Name (required)
I agree that I have read all of the information provided on this form and that all of the above information I have provided is true. (required)

Yes, I agree



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