Grooming Check-in & Sedation Consent

GROOMING - CHECK-IN

The following health history/risk assessment communicates valuable information to your Groomer or if your pet is sedated, your pet's anesthetist when they are here grooming. It should take about 5-10 minutes to thoughtfully complete this form, and is best completed by your pet's primary caregiver.
Pet's Primary Adult Caregiver - Full Name*

First NameLast Name
Preferred Phone Number*

Area CodePhone Number
Optional - Valid Caregiver E-mail
Optional - Pet's Other Adult Caregiver(s) or Contact Numbers
Is anyone else authorized to pick up the pet?
When Patient is In Ready to Be Picked up or Discharged, How Would You Like to Be Contacted?

TextPhone CallOther
Pet Patient's Name*
Date of Scheduled Grooming

MonthDayYear
Date
My Pet is Primarily a Patient*

At Highland Veterinary Clinic - You have access to his/her complete health historyAt a different veterinary facility, and is a grooming guest at HVC
Is Sedation Grooming Planned During Your Pet's Grooming Visit?*

My Pet is scheduled for sedation groomingMy Pet is NOT scheduled for sedation grooming--Crystal will call or text the number above if your pet cannot be groomed safely without medication
Laboratory History for Sedation Grooming

Browse Files
Each grooming patient must have pre-anesthesia labs performed prior to sedation grooming. These lab results and exams are usually required within a month of your appointment, as well as an examination. If you have not obtained this service from your primary veterinarian, we can perform this service here during your pet's appointment. Please text 812-867-6651 to request a fee estimate. Cancelof
Any Specific Patient Handling Preferences or Questions for Crystal?

Admission for Services & Informed Consent

By Signing Below You Agree You are 18 years of Age or Older
I understand that vaccinations are meant to protect and guard against infectious disease and this course of action is the advised course of action to prevent infection, however, immunization titers may take 7-10 days to provide protection against infectious disease and release Highland Veterinary Clinic from all liability resulting from infectious disease. *

Signature (Mouse, Touchpad, or Touchscreen Enabled)
I understand that all patients must be admitted free from external parasites (fleas and ticks) and free from apparent internal parasites (intestinal worms, etc) and that evidence of parasitism will cause any patient to be treated at the owner's expense. I understand that I will be called or texted prior to treatment, but if no reply is offered within an hour of Crystal's call, then I will owe Highland Veterinary Clinic $9.00 for a one month topical treatment of Provecta.*

Signature (Mouse, Touchpad, or Touchscreen Enabled)
I am the owner or the authorized agent for the owner of the animal described above, and I have the authority to execute this consent. My signature below certifies that I am over eighteen years of age.

I understand that my pet is going to be examined and monitored by veterinary personnel prior to and during my pets sedation and recovery. I understand that the fees for examination/monitoring of $25-50 (depending on frequency of visits); periodic laboratory services at a rate of $78.88; and grooming sedation $38-$50 (depending on size), is due to Highland Veterinary Clinic for sedation services and will be payable upon patient pick up. I understand that Crystal O'Mullane's grooming services are due at pick up and are a separate payment to be processed by Crystal O'Mullane.

I have been informed that there are certain risks and complications associated with sedation, anesthesia, as with any veterinary procedure and that the risks/complications have been explained to me. I further understand that during the course of the sedation-related procedure, or veterinary treatments, unforeseen conditions may arise that may necessitate the performance of additional procedures deemed necessary by the veterinarian. I am encouraged to discuss any concerns I have about these risks with the attending veterinarian before the sedation and grooming is initiated.

My signature below FUTHER VERIFIES that my pet has NOT/will NOT eat any food after 9pm the night before my pet's sedation related procedure, and will only take in clear liquids by mouth. I understand that failure to comply with this instruction can result in serious harm or injury to my pet, their GI tract, and their airway when sedated or given anesthetic drugs.
Signature (mouse or touchscreen)
Signature Name

First NameLast Name
Should be Empty:

GROOMING - CHECK-IN

GROOMER PREPAREDNESS

HEALTH CONDITION - SEDATION GROOMERS

HEALTH CONDITION - GROOMING

Admission for Services & Informed Consent