East Holland Veterinary Clinic
Surgical Consent Authorization
Please enter patient's first and last name (ie Fluffy Smith)
Surgical Procedures Include
Anesthesia, IV catheter, anesthetic monitoring, pain therapy including a therapeutic laser; Declaws will also receive local pain control(nerve block) & special litter
I hereby consent and authorize for the following procedure(s) be performed
Canine Spay $290-380
Canine Neuter $270-315
Feline Spay $265-305
Feline Neuter $160-180
2 paw Declaw $260-300
4 paw Declaw $355-440
Feline Spay w/ 2 paw declaw $380-410
Feline Spay w/ 4 paw declaw $460-490
Feline Neuter w/ 2 paw declaw $275-300
Feline Neuter w/ 4 paw declaw $325-355
Growth/Mass removal- Timed procedure
Dental Prophylaxis Include
Ultrasonic scaling, Full Mouth digital X-rays, Anesthesia, IV catheter, anesthetic monitoring, pain therapy including a therapeutic laser. The veterinarian will evaluate dental x-rays and oral cavity and make recommendations according to findings.
I hereby consent and authorize for the following procedure be performed
Dental Prophylaxis- $360-490
Oral surgery recommendations- Only required if here for Dental procedure
Extract teeth as recommended by veterinarian (Additional Fees will apply)
Do not extract any teeth without my permission- If unable to be reached your pet will be woken up from anesthesia without extractions performed. An additional anesthetic procedure will be necessary to extract teeth.
Blood work is recommended prior to undergoing anesthesia to detect internal issues that may not be readily evident upon physical examination. This blood work allows your veterinarian to assess your pet's overall health, ensuring that your pet is a good candidate for anesthesia.
Optional Services Available- Pre-anesthetic lab work will help the doctor evaluate your pets internal organ function ensuring they are healthy enough to go under anesthesia.
Minor Chemistry & CBC $126.89
Major Chemistry & CBC $131.60- Strongly recommended for patients over 8yrs of age
Microchip implant ($49.00- includes chip implant & 1st year registration fee)
No Optional Services
I understand that for elective procedures, my pet must be current on annual recommendations as required by EHVC (ie; DHLPP, Rabies, Bordetella, Heartworm test, Fecal, FVCR) *Additional fees will apply
Please update vaccines as required
I would like to discuss at time of drop off
I authorize additional health care as warranted by the veterinarian. (ie; ear cytology, baby teeth extractions, anti-nausea medication etc) *Additional fees may apply
In the event of an anesthetic or surgical emergency, I authorize treatment. (ie. IV fluids, injectable medications, resuscitation)
Do Not perform CPR
I agree to be held financially responsible for veterinary services provided to my pet while staff pursue treatment and try to reach me further directions. Regardless of my pet's recovery or survival, I agree to pay CPR fees in addition to other fees already identified by the practice and agreed upon by me.
Flea/Tick prevention requested
All set on Flea/Tick
Qty requested today
All set on Heartworm prevention
Qty Requested today
I understand that I assume full financial responsibility for all services rendered and that payment is due on the date of procedure. I am aware that any quote given is an estimate of incurred fees and while every effort will be made to stay within those guidelines, we cannot always anticipate additional charges which may occur.
Please leave a good phone # that you will be available at while your pet stays with us.
If you have any questions or concerns please contact the clinic @ 616-392-1835.
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