Procedure/Drop Off Form Procedure Drop Off Form Name * Name First First Last Last Email * Phone * Patient Name * Species * Dog Cat Bird Small Mammal Reptile Amphibian Fish Sex * Male Male/Neutered Female Female/Spayed Unsure Today's Procedure * When did the patient last eat? * Does your pet need refills on any medication(s)? * Was the patient given any medications this morning? * To ensure your pet's safety during anesthesia we recommend preanesthetic bloodwork. Our Comprehensive Blood Panel includes a Complete Blood Count that will let us know if there is infection, inflammation, or anemia and a Blood Chemistry Panel which checks for organ function prior to surgery. On birds and reptiles only a Blood Chemistry Panel can be done preoperatively, please select one option. Yes, I accept Comprehensive Blood Panel ($240) MAMMALS ONLY Yes, I accept Blood Chemistry Panel ($160) BIRDS & REPTILES No, I decline If your pet is having a surgical procedure and/or suffers from an acute or chronic illness laser therapy reduces pain and inflammation, it also speeds healing and wounds. Would you like to add a session today? Since repeated laser sessions are much more beneficial, packages of 6/5 are available. Yes ($40) Yes, 6 sessions for the price of 5 ($200) No, I decline N/A Please select any additional services (fees apply) Microchipping Wing Trim Nail Trim Beak Trim Ear Flush Bath Would you like to receive text message/picture message updates * Yes (please provide a text-capable cell phone number above) No In the devastating event that your pet were to deteriorate and experience a cardiac or respiratory arrest, our standard procedure would be to initiate CPR. Please note that costs of this can range from $150-300 per 15 minute session depending on nature and duration of intervention. Under certain circumstances the veterinarian may recommend that resuscitation not be performed; as a pet owner you may prefer not to have resuscitation performed. In such cases you have the option to elect a Do Not Resuscitate (DNR) order. Please note that recovery rates after CPR under anesthesia are better than rates after CPR due to illness or trauma. * Yes, I do wish to have CPR performed No, thank you. If my pet passes away please do NOT resuscitate him/her The most common complications of any sedation/anesthetic/surgical procedure would include: nausea/vomiting, discomfort, weakness. The most serious complications of any sedation/anesthetic/surgical procedure would include bleeding, infection, surgical failure, organ failure and/or death. Although these are rare it is important that you understand that such complications are possible. By checking the boxes below you grant permission for Exotic Vet Care to perform the above procedure. * I, the undersigned owner or agent of the pet identified above, authorize the staff of Exotic Vet Care to perform the above procedure(s). I understand that some risks always exist with sedation/anesthesia/surgery and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure(s) are initiated. While accepting that all procedure(s) will be performed to the best of the abilities of the staff at Exotic Vet Care, I understand that no guarantee or warranty has been made regarding the results that may be achieved. I assume full responsibility for any additional expenses incurred after the procedure is performed, such as follow up radiographs, re-check physical exams, and additional surgery due to post-op complications. These are more likely to occur when there is a failure to comply with the aftercare instructions. I have read and fully understand the terms and conditions set forth. Additional questions regarding the recommended procedure * Signature * signature keyboard Clear Date * Captcha Submit If you are human, leave this field blank.
