Submitting this form does not schedule you an appointment for boarding. You will need to call the clinic directly for scheduling.

Pre-Anesthesia Consent Form

Pre-Anesthesia Type(*)
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Client/Patient Info

Owner's Name(*)
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Email(*)
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Date(*)
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Pet's Name(*)
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Species(*)
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Client Number
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Breed(*)
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Color
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Age
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Consent Info

As the owner or agent of the above animal, I hereby give my consent to the Animal Hospital to perform the following on my pet.
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Like you, our greatest concern is the well being of your pet. Prior to administering anesthesia to your pet, a full physical exam is performed. Included in the price of each procedure is: (1) an intravenous catheter and fluid therapy, (2) pain medication before, during, and after the procedure, (3) state of the art anesthesia monitoring.
Pre Anesthetic Blood Testing(*)

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A blood analysis can reveal underlying problems that may not be outwardly visible. This test provides us with a look at your pet’s vital organ function which can play a critical role in determining how much risk is involved. Before administering any anesthetic, a doctor will evaluate these test results.

Additional Pain Medication(*)

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I request an injection of Buprenex (an opioid) during surgery and Carprofen (an anti-inflammatory) to take home to aid in pain relief and healing

Microchipping(*)

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30-40% of all pets will get lost in their lifetime. We recommend all pets be permanently identified through the use of a microchip implanted under the skin. This quick and simple procedure gives your pet permanent identification that will assist in the return of your pet if found and scanned by and animal shelter or veterinary hospital.

Primary Contact Number(*)
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Alternate Contact Number(*)
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I, the undersigned, do hereby certify that I am the owner or duly authorized agent for the owner of the animal described above and have the authority to execute this consent.

I understand that during the performance of the procedure, an unforeseen situation may arise that necessitates an extension or variance in the procedure set above. I hereby authorize the Animal Hospital to use reasonable care and judgment in performing the procedure.

I have been advised as to the nature of the procedures and the risks involved in performing general anesthesia to the above described animal. I realize that results cannot be guaranteed.

I have read and understand this authorization and consent. I further understand that I assume financial responsibility for all services rendered.

By pressing the submit button, I, the owner of the above pet, agree to all of the above statements.

Boarding Consent Form

Client/Patient Info

Owner's Name(*)
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Email(*)
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Date In(*)
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Date Out(*)
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Pick Up Time(*)
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Pet's Name(*)
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Client ID
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*All boarded animals are required to have a negative intestinal parasite screening within the last (6) months as well as proof of being current on the following minimal vaccinations*: Dogs: Distemper, Parvovirus, Bordetella (annually), Rabies, Canine Influenza Cats: Ent-Fvrc, Rabies

Boarding Info

General Dog Boarding

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Cat Boarding

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Hospital food is provided at no additional cost.

Other Info

Special Instructions, Medications, Special Diets (Special diets and all medications must be provided by the owner.)
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Additional services are available for your pet while boarding (Please check all that apply)

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Emergency Contact Name & Number(*)
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*The Animal Hospital will NOT be responsible for toys and bedding. All precautions will be used against injury and escape of this pet. The Animal Hospital will not be held liable for destroyed/ingestion of bedding and toys, or aggressive behavior that develop between boarding “mates” provided that reasonable care and precautions are followed.
By pressing the submit button, I grant permission for any necessary veterinary emergency treatment and care during my pets boarding stay and realize that I am responsible for cost.

Drop Off Exam Questionnaire

Client/Patient Info

Client Name(*)
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Email
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Patient Name(*)
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Date(*)
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What do you need performed on your pet today?(*)

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Patient Problems

Please check the significant problems that apply to your pet.

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How long has your pet displayed these problems?
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Has your pet had any previous problems?
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Eating Habits

Describe your pet's drinking habits

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Describe your pet's eating habits

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What are you currently feeding your pet?

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What brand?
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Is this a recent change?(*)

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If yes, what were you previously feeding?
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Urine/Bowel Habits

Describe your pet's urine habits

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Describe your pet's bowel habits

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If Diarrhea

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Other Patient Info

If your pet has lumps, bumps, cuts, sores that you wish to have us look at please describe the location.
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Where does your pet spend his/her time?

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Is your pet currently receiving any other medications? Please list medications and daily dose.
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Other Client Info

Please list any other comments or questions you have for the doctor
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In order to diagnose your pet's condition, your pet may require blood tests, xrays, and/or other diagnostic testing. Do you authorize tests if the doctor feels it is warranted?

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Please select any additional services that you would like performed while your pet is in the hospital.

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It is very important that the doctor is able to contact you if he/she has questions regarding your pet. Failure to be reached may result in postponement of treatment.
Primary number you can be reached today(*)
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Alternate number(*)
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Drop off exams are offered for your convenience. Your pet will be examined when the doctor's schedule allows. (Critical patients will be examined immediately). Pick up times cannot be guaranteed.
By pressing the submit button, I, the owner of the above pet, authorize the Animal Hospital to examine, diagnose, and treat my pet as approved above.

“Took my older cat in last night as she was failing fast. Very nice staff and Dr Kasparek is awesome. Trixie has kidney disease and I am comforted to know that she is being taken care of for now.”

Annette J. - Henderson, NV