• Please Initial One:

  • What vaccinations/tests, if needed, would you like us to give your pet today?
  • Microchip:
  • If your pet is to be anesthetizedRest assured that advances in anesthesia and surgery have made routine procedures relatively safe with a low rate of complications. Nevertheless, occasional problems can arise due to pre-existing conditions not evident during routine pre-anesthetic examinations. To avoid these problems, we recommend that all of these cases be screened prior to anesthesia. Our surgeries include the placement of IV catheters, which offer access to a central line while your pet is under sedation. Understand that anytime an animal is anesthetized, there is a risk that anadverse reaction may occur potentially resulting in death.
  • IV Fluids:
  • Pre-Anesthetic Blood Screen:
  • Pain Medication:
  • Owner Release: I authorize Animal Medic al West to perform the above procedures on my pet; and in the event additional procedures are deemed necessary, an attempt will be made to reach me before proceeding, but if they are unable to reach me, I authorize the veterinarians to perf orm any necessar y procedures. I agree to pay fees for all services rendered at the time the pet is discharged from Animal Medical West, or the service is otherwise terminated. I agree to pay for the reasonable costs of collection, attorney’s fees, and court costs in the e vent that collection efforts become necessary. I agree that the venue of this action will be in the county where the hospital is located. If I neglect to pick my pet up within 7 days from the date below and do not notify you within that time frame, you may assume that the pet is abandoned and are hereby authorized to dispose of the pet as you deem best or necessary. I further understand and accept that the owners and staff will not be held liable for any injuries, escapes or death sustained by my dog while under the care of Animal Medical West. Written estimates expire after 30 days and verbal estimates are not binding. Prices and fees are subject to change