775-329-4106 ... [email protected] ...

Mon - Fri: 7:30 am - 6:00 pm | Sun - Sat: Closed

We are now accepting new clients! Give us a call and get $25 off your first visit.

Surgery Authorization

Please fill out this form as completely and accurately as possible.

Get Started

Hospital/Surgery Admittance and Authorization Form

f you have any questions, please feel free to contact us at 775-329-4106.

Surgery Authorization Form

Name(Required)
I certify that I am the owner of my pet and am over 18 years of age.(Required)
All pets entering the hospital must be free of internal and external parasites (fleas, ticks, roundworms, tapeworms, etc.) or they will be treated at the owner's expense.(Required)
The hospital requires that your pet be current on vaccines prior to being admitted to the hospital. If I cannot provide proof of these vaccines, I understand they may be done while my pet is here, at my expense.(Required)
I have received a verbal or written estimate on today's procedure(s) for my pet(s) visit to the hospital.(Required)
I understand there is a hospitalization charge for all pets staying in the hospital for 1/2 or full day.(Required)
I understand if my pet undergoes general anesthesia he/she will have an IV catheter placed and receive IV fluids during the procedure for his/her safety (with the exception of feline neuter).(Required)
Fairgrounds Animal Hospital is not a 24-hour Hospital. We do NOT have a staff member at the hospital overnight. I understand that the continuous presence of personnel is not provided during nighttime hours or weekends. I have the option of taking my pet to The Animal Emergency Center if such care is deemed necessary. I understand and agree that if I do not come for my pet by 6 pm and he/she is not stable enough to stay at the hospital unattended overnight, he/she will be admitted to the Animal Emergency Center and treated at my expense.(Required)
Please acknowledge the above items are true(Required)
LASER: A one-time photon laser healing therapy session is performed for post-operative incision care, treatment of inflamed tissues, and many other conditions involving pain, inflammation. I authorize the administration of oral medications, including controlled substances, to my pet if prescribed by my veterinarian. I understand these medications may be administered by a veterinary assistant.(Required)
CPR: In the event that an emergency should arise, I give permission for the doctors/staff to perform/use lifesaving measures such as CPR. As in humans, cardiopulmonary resuscitation (CPR) is an emergency technique used when an animal has stopped breathing and has no heartbeat. It involves rescue breathing (mouth-to-snout resuscitation) and chest compressions. (Additional cost begins from $300.00 to $1000.00)(Required)
Bloodwork: Please select one permission level(Required)
Pre-surgical bloodwork is strongly recommended by Dr. and may be required depending on your pet's age and/or health status. Pre-surgical bloodwork is required for all senior pets (over 7 years old). If bloodwork is optional, if bloodwork is declined, I understand and accept all potential risks involved including but not limited to: acute or acute on chronic renal failure, liver failure, GI ulceration/perforation, heart failure, hemorrhage.(Required)
An ECG in preoperative diagnostic screening is one of the most cost-effective measures we can take to ensure patient's safety during anesthesia. There is an additional charge for this screening test.(Required)

Additional Services You Would Like

Would you like any of the following services done while your pet is sedated or under anesthesia today?(Required)

Financial Policies

Payment Method
Please initial here

Photo and/or Information Release for Media or Website Publication

Please initial here

Release Agreement/Terms and Conditions

Please initial here
Please initial here
Emergency Contact Name(Required)
This field is for validation purposes and should be left unchanged.