PETCARE Animal Hospital Surgery Request Appointment

PETCARE Animal Hospital Surgery Request Appointment
Hello! Thank you for wanting to schedule a procedure with PETCARE Animal Hospital.

If you are a new client, please do NOT fill this form out until AFTER you have been seen by one of our veterinarians - our surgery coordinator cannot schedule you until you have been established with our facility. If you are new to us, please call and schedule an examination with our front desk at 801-302-9061.
Client Information
Are You A New Client? *

No Yes (Please Call and Schedule an Examination with the Front Desk - The Surgery Coordinator CANNOT Schedule You Until You've Been Seen by One of Our Veterinarians - FYI Surgeries are Currently Booking Out 2-3 Months)
Name *

First Name Last Name
Email *
Please provide an email in which you can receive documentation, including the itemized estimate.
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Cell Phone Number *
Please enter a valid CELL phone number. Sage, the surgery coordinator, will get in contact with you via TEXT.
Doctor Preference *

No Preference Scott Matheson DVM DABVP (Canine & Feline Practice) Darin Emch DVM
As of June 2022, we will only be performing surgeries on WEDNESDAYS! Some surgeries may need to stay overnight.
Month Preference - Not Guaranteed (Select All That Apply) *

Any January February March April May June July August September October November December
Patient Information
Has This Pet Been Seen By PETCARE Animal Hospital? *

Yes No
Surgery Needed *

Spay (Dr Emch ONLY) - Females Neuter - Males Umbilical Hernia Repair Cryptorchid (1 Testicle That Has Not Dropped) - Males Cryptorchid (Both Testicles Have Not Dropped) - Males Retained Baby Teeth Gastropexy (Stomach Tack Down) Dentistry Tumor / Mass / Cyst Removal Canine Dewclaw Removal Puppies Tails or Dewclaws (must be between 3 days and 5 days old) --> PLEASE CALL THE OFFICE AND SCHEDULE WITH THE FRONT DESK STAFF Microchip Placement Fracture Repair - Dr Matheson ONLY Tightrope ACL Repair - Dr Matheson ONLY Cherry Eye Tack Entropion Repair (Eye) Other
Pet Name *
Species *
Gender *
Breed *
Pet's Weight (Approximately) - in Pounds *
Pet Date Of Birth

Month Day Year
Date
Or Approximate Age (Weeks / Months / Years)
Has Your Pet Required Any SPECIAL Handling Before - Please Select Any That May Apply *

No Difficulty Handling Requires Muzzle, OK to be Placed by Veterinary Staff Requires Muzzle, Can Only Be Placed by Client Requires Oral Medications for Sedation (Including: Acepromazine, Gabapentin, Trazodone, etc...) Requires Injectable Medications for Sedation Requires Anesthesia for ANY Handling Other
Comments On Surgery Needed (if applicable)
Vaccination Record - All vaccinations must be up to date for surgical patients. If we do not have record on your pet, we will update them at your expense. VACCINATIONS MUST BE PERFORMED AT LEAST ONE WEEK PRIOR TO PROCEDURE. Thank you. *

Cancel of
NOTE: FOR THE VACCINE RECORD, YOU SHOULD BE ABLE TO TAKE A PHOTO OF THE VACCINATION CERTIFICATE IF YOU ARE HAVING TROUBLE UPLOADING A DOCUMENT.

*If you were an existing client and have performed vaccines through PETCARE, please ask our front desk to email you a vaccine certificate, otherwise you will not be able to complete this form - sorry, we know this is a bother but unfortunately too many people (who have not performed vaccines here) failed to attach the certificate so now everyone is required to.
Vaccination Status *

Vaccines done in the last year by a licensed veterinarian (can provide documentation) No vaccines done in the last year - I need to schedule an appointment to update them Has never been vaccinated
I Understand by Pet Needs the Following Vaccinations: Dog - Rabies, Distemper Parvovirus, Bordetella, and Canine Influenza. Cat - Rabies, Feline Distemper, Feline Leukemia. These are REQUIRED for surgery and cannot be waived. *

Yes
Bloodwork (Unless Performed in the Last Six Months of Surgery Date) is Required to Be Done at Least ONE Week Prior to Surgery. I Acknowledge The Surgery Coordinator Will Schedule Me to Have Bloodwork Performed At Least One Week Prior to The Procedure Date *

Yes
Procedure Information
FAQ

When Will the Surgery Coordinator Get in Contact with Me?: Sage, our surgery coordinator will get in contact with you within FIVE business days.

How Will the Surgery Coordinator Get in Contact with Me?: Sage will get in contact with you via TEXT.

I'm a New Client or Have a New Patient, Do I Have to Have An Examination Before I Can Be Scheduled? Yes, you must have an examination before being scheduled. We want to provide the best care possible and that is much more difficult if we have never seen you or the pet. Also, by having the examination by the veterinarian - you can update vaccinations or have their pre-surgical blood work done at that time.

Estimate of Cost: An estimate will be emailed to you at the time of scheduling. For single procedures, you may also find the consent form below. The emailed estimate is solely for your information. You do not need to fill it out and email it back.

Days of Surgery: Surgeries are performed WEDNESDAYS only!

Admit Times for Surgery: Admit times are between 8am and 8:45am - the surgery coordinator will assign you a time between that time frame. If you are unable to admit your pet between 8am and 8:45am, you have the option of admitting the night before between 4pm and 5:30pm. There is NO additional fee for admitting the night before.

How Far are You Scheduled Out?: Most Procedures are Currently Booked out 2-3 months. You may also ask to be placed on the cancellation list if anything opens up sooner (just comment in the surgery comment field if you would like to be placed on the cancellation list).

Discharge Times: For spays/neuters/dentals/mass removals, they will go home same-day between 5pm and 5:45pm. After the procedure has been performed, the nurse will contact you and assign the discharge time. If your pet is needing an orthopedic procedure or feline declaw, they will go home the next day if doing well.

Should I Take the Day Off (of Work) for My Pet's Procedure?: That is completely optional. Your pet will be with PETCARE most of the day so if you are wanting to take a day off of work to be with your pet, it is actually more beneficial to take the day AFTER the procedure off of work.

My Pet Has Received Medications, When Do I Start Them?: If your pet receives medications after the procedure, you should start them around 7pm that evening, unless specified otherwise.
Consent Forms
Consent Forms (For Multiple Procedures at Once): If your pet needs multiple procedures at the same time (example: spay and mass removal) then you will receive an itemized estimate in your personal email (that you listed above). The consent forms below do NOT apply for multiple procedures.
Consent Forms (For Single Procedures): You May Use the Following Link to Fill Out Your Pets Procedure (If Spay ONLY, Dental ONLY, Neuter ONLY), as well as get an estimate for their procedure. If you chose not fill out the consent form ahead of time (not required), you will fill it out at the time of the blood work.

Dog Spay: tinyurl.com/petcarecaninespay

Dog Neuter: tinyurl.com/petcarecanineneuter

Dog Dental: tinyurl.com/petcarecaninedental

Cat Spay: tinyurl.com/petcarefelinespay

Cat Neuter: tinyurl.com/petcarefelineneuter

Cat Dental: tinyurl.com/petcarefelinedental
Signature: I acknowledge if I do not respond within SEVEN days of contact from Sage at PETCARE, my suggested time slot for my pet's procedure will be released/opened to others. *

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PETCARE Animal Hospital Surgery Request Appointment

Client Information

Patient Information

Procedure Information

Consent Forms