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Curbside greeting and drop-off service now available at Island Pet Veterinary Hospital during COVID-19.

Surgery Admission Form

APPOINTMENT

We can’t wait to see you!

Please complete this form before your surgical appointment.

Thank you for dropping off your pet with us today! The following information will be used to help our veterinary team accurately complete your pet's medical history for today's visit.

We will need to be able to contact you or someone with permission to make medical and financial decisions.

In-Patient Questionnaire

Blood Work & Additional Services

Please note: Pre-anesthetic blood work checks the internal organs and blood count and is a vital part of safe anesthesia. Help us provide the best level of care for your pet by choosing to perform blood work prior to anesthesia or sedation.

Full Chem and CBC - $90

  • Full blood work on all major organs and full red and white blood cell count
  • Indicated for longer anesthetic procedures and sick patients.
** Required for pets over the age of 8 years old** *** Note – We may require this blood work for some procedures and situations  
 

Partial Chem and CBC - $70

  • Basic internal organ screen (liver, kidneys) with full red and white blood cell count
  • For generally healthy, younger patients.
**Required for pets over the age of 5 years old**

Additional Tests/Services

Authorization

I, the owner/agent of the pet described above, authorize the above procedure(s) to be performed. I understand that it may be necessary for the health and safety of my pet to provide medical and/or surgical procedures not anticipated.

 

I hereby consent to and authorize the performance of such procedures and accept financial responsibility for any resulting additional charges. I understand my pet will be going home with medications deemed necessary by the veterinarian and these medications are NOT optional.

 

I understand payment is due in full at the time of my pet's discharge and agree to be responsible for any and all charges incurred. I understand that no staff will be attending my pet overnight (any pets needing overnight care will be referred to an overnight facility).