Bay Animal Hospital Surgery Admit Form

Bay Animal Hospital Surgery Admit Form

3891 Dupont Parkway, Townsend DE 19734 Phone Number: (302) 279-1082 E-mail: bayanimalde@yahoo.com
Owner Name: *
Patient:*
Date:*
Procedure:*
Has your pet been given any aspirin or other medications within the last 48 hours?*

YESNO
If yes, what medications?
Has your pet had any seizures?*

YESNO
Pre-operative blood tests are always recommended and/or required before a procedure for your pets’ safety.*

I would like to have pre-operative blood tests performed today before surgery.My pet has already had pre-operative blood tests run prior to this surgery.I decline pre-operative blood tests for my pet.I have not given the above patient any food after 10pm on the night before the procedure.I understand this is important for anesthetic safety.
I would like to have the above patient microchipped today for an additional $45.50.*

YESNO
If yes, when?
If unforeseen conditions arise which, in the judgment of the attending veterinarian, require procedures and/or treatment other than those authorized in this release, and staff are unable to contact me or my authorized agent at the phone number provided, I assume full responsibility for treatment expenses incurred.*

YESNO
I certify that I am the owner, or authorized agent for the owner over the age of 18 years old, of the above animal. I hereby consent to and authorize the doctors and staff at Bay Animal Hospital to admit this pet, perform the above-described procedures, and administer medications, anesthesia, surgical procedures, tests and or treatments that the doctors deem necessary for its health, safety and well-being while under their care and supervision. I have been advised of the nature of the procedures and the potential risks and benefits. I understand that veterinary medicine is an inexact science and that no guarantee of successful treatment can be made. I acknowledge that I am responsible for payment in full for the above procedures and treatments at the time my pet is discharged.
Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
2nd Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Date:*

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Date
Signature:*
Should be Empty: