Surgical Check In Sheet

Surgery

Labs

Services

Medications

Is your pet currently taking any medications? If yes, please list:

Other Procedures/Services to be performed:

Presurgical blood work recommended for all surgery patients
Additional cost of $66

Owner's representative or I as owner, authorize the above procedures to be performed for my pet. If an unforeseen medical or surgical need arises, and I am not available, I grant permission for the necessary care to be administered. This includes application/administration of flea prevention if fleas are noticed on my pet to prevent spread to other hospitalized patients. I understand that I assume financial responsibility for services provided and that payment is due at time of discharge.