Please help us provide the best care for your pet by responding to the following questions prior to your pet's scheduled appointment. This will save time for you and us before starting your pet's appointment. Thank you!

By Signing this document you certify that you own or have permission of the owner to consent Valley West Veterinary Hospital and its staff to hospitalize, administer treatments, and perform procedures deemed necessary by the attending veterinarian for the welfare of your pet. I also understand that by signing I am taking full responsibility for payment, treatments, and procedures upon discharge of the pet.

I. ADMISSION REQUIREMENTS: In order to be admitted for surgery, your pet must be up to date on his/ her wellness exam and necessary vaccines (Rabies, Bordatella, DHLPP, and FVRCP). If your pet is not up to date, these vaccines will be given.

II. PRE-ANESTHETIC SCREENING (ADDITIONAL COST) The purpose of pre-anesthetic screening is to assess the risk associated with sedating and/or anesthetizing your pet, however, please note these tests are only a guide and do not eliminate all risks. Specifically, an ECG is a tool used to assess the rate and rhythm of a patient's heart. This is of particular significance when under anesthesia and may also help in the early detection of cardiac disease. The lab work gives us insight into the breakdown of the drugs used for sedation and anesthesia by looking at liver and kidney functions, blood sugar levels, potential sites of infection, and again may help in the early detection of disease.

If your pet is here for a mass removal would you like the mass to be sent to an outside lab for histopathology? (for an additional cost)
Does your pet need any additional services while with us today? Please select all that apply. These are at an additional cost.
ELIZABETHAN COLLAR/ SURGICAL SUIT: An Elizabethan Collar (soft cone that goes around pets head) or surgical suit (body suit to cover the incision)  will be sent home with your pet for an additional charge after surgery to prevent certain complications.  If you decline this service you may be responsible for any charges that may incur for follow up visits due to complications.
Would you like to purchase the E-collar?
Would you like to purchase the Surgical Suit?

PAIN MANAGEMENT POLICY: To allow your pet to rest comfortably after surgery we routinely administer an injection post-surgery to relieve discomfort and pain. In some cases, additional pain medications will be prescribed and sent home with you at the doctor's discretion.

What procedure is your pet here for today?

ANESTHESIA CONSENT: I authorize Valley West Veterinary Hospital to perform a procedure on my pet that requires general anesthesia. I understand that results cannot be guaranteed, and that anesthesia can always carry potential risks to the life and health of my pet. I am aware that in rare cases, medical complications may arise which will be treated in prompt and aggressive manner by the medical staff of Valley West Veterinary Hospital, including but not limited to the use of emergency drugs, cardiac compression and artificial respiration. I assume full financial responsibility for this animal, for all the procedures required and requested either on this form or by phone.    

Sign above