Anesthesia Check-In Form

Pre-operative instructions – No food OR water after 11:00PM the night prior to surgery and nothing the day of the procedure.

Hospital discharge times vary so please pay attention to the time that the Veterinarian gives you. Weekends discharge times are between 9:30 A.M. to 4:30 P.M. We do not discharge patients from the hospital on holidays when the hospital is closed.

Hospital policy requires a minimum of 100% of the low end of the estimate be paid on deposit at the time of admittance to the hospital and the balance to be paid in full upon discharge from the hospital.

Please be aware that your pet’s hair/fur will be clipped as needed to facilitate diagnostic and therapeutic procedures and you are agreeing this by signing this document. You should be aware that most hospital procedures require some shaving of hair or fur.

DENTAL/MEDICAL AND/OR SURGICAL TREATMENT CONSENT

During the physical examination, it is often not possible to completely evaluate the degree of dental disease. Only when your pet is under anesthesia, can a thorough examination be carried out.

Because of this, certain dental problems (such as loose or diseased teeth requiring extraction) may be later discovered during anesthesia, after you have left the hospital. We try to make preliminary estimates accurately, but this is not always possible in the examination room.

We are therefore presenting you with the option of allowing us to perform these necessary dental procedures discovered at the time of anesthesia. If declined, your pet will have a dental cleaning, polishing, and up to three extractions only; any additional work will not be performed, but you will be later informed about these problems with the estimate of cost which you may choose to have performed at a later date (which will require an additional procedure under general anesthesia).

Hospital policy requires a minimum of 100% of the lower end of the estimate be paid on deposit at the time of admittance to the hospital.

AUTHORIZATION FOR MEDICAL AND/OR SURGICAL TREATMENT

The agreement made this date between Animal Kind Veterinary Hospital & House Calls for Pets, hereafter called the Hospital, and the person named above, who represents himself or herself to be the Owner of the animal described above or an authorized agent for the Owner, hereafter called the Owner.

The Owner authorizes the Hospital to perform such diagnostic tests and to provide such medical and surgical treatment as it deems advisable for the health, safety, and well-being of the above-described animal. The Owner further consents to the administration of anesthesia and intubation procedures associated with the administration of anesthesia to be applied by or under the supervision of a licensed veterinarian when it is determined by the Hospital that the use of anesthesia and intubation procedures are deemed necessary and advisable for the animal.

The Owner acknowledges the total estimated fee to be as indicated above. However, the Owner realizes that in some cases, it is impossible to determine in advance the extent of medical or surgical treatment required for the animal. The Hospital has attempted to estimate the cost of treatment, but it is understood that the actual cost may exceed or be lower than this estimated cost depending upon the extent of treatment and the length of hospitalization required. The Owner agrees to pay such actual cost, even if it exceeds the estimated cost as specified above at the time of discharge from the Hospital.

The Owner agrees to contact the Hospital daily to obtain a progress report and the date the animal can be released to the Owner. If the Owner does not remove the animal on the date determined by the Hospital, the Owner realizes that the fees for treatment and hospitalization will continue to be charged to the Owner. The Owner further agrees that if the animal is not removed from the hospital within five days of written or telephone notice to do so, it will be considered abandoned and Owner relinquishes all claims to the animal, and the Hospital is at liberty to determine the disposition of the animal.

The Owner agrees to the clipping of hair or fur as deemed necessary by the Hospital to facilitate diagnostic and therapeutic procedures.

If the Owner defaults in payment of any balance due, the Owner will pay all reasonable court and legal fees incurred in collecting the balance due. This contract is binding.