Please list all procedures that your pet is having done today. (Required) Please list any concerns that you have about the procedure your pet is having today. (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 Photo and/or Information Release for Media or Website Publication After an explanation of its intended use, I authorize the staff at Fairgrounds Animal Hospital to release portions of my pet's photographs, video images, or other images to use with the following media entity(ies): Fairgrounds Animal Hospital website/brochures, social media platforms (Facebook, Twitter, Pinterest, Yelp, etc.), television, and in the print media. I understand that this information may be used for advertising and/or public education purposes. I, the undersigned, allow my and/or my pet's name to be used along with photographs, video, or other images of my pet. I, the undersigned, authorize this veterinary practice or institution's faculty, clinicians, employees, students, and/or agents to use such materials for the purpose of educating the public about my pet's condition and medical care. I agree not to file any claim for revenue or lawsuit for damages against this veterinary practice with respect to the release of this information.
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Release Agreement/Terms and Conditions I/we being the legal owner and at least 18 years of age hereby consent and authorize you to receive, prescribe for, treat, or operate upon the above-described animal(s) and any future pets registered. You are to use all reasonable precautions against injury, escape, or destruction of the animals(s), but you will not be held liable or responsible in any manner whatever, or any circumstances, on account of the care, treatment, or safekeeping of the animal(s) above described, or otherwise in connection herewith, as it is thoroughly understood that I/we assume all risks. I/we will assume full responsibility for all charges incurred in the care of the above-described animal(s). I/we also understand that these charges will be paid in full at the time of release with the knowledge that we do not offer billing. I/we also understand that a deposit may be required for certain surgical treatments or other procedures.
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Emergency Contact Name (Required)