Surgical Leg
Pet's Name:
First Name
*
Last Name
*
Species:
Canine
Feline
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Sex:
Male
Female
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Owner's name:
First Name
Last Name
Leshem Veterinary Surgery is performing surgery on the following leg on my pet:
Right Rear Leg
Left Rear Leg
Right Front Leg
Left Front Leg
Unknown - I will meet with LVS staff at admission to determine which leg
Signature
*
Date
*
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Month
-
Day
Year
Date
Submit
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