General Surgical Consent Form
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1
2Blackhorse Animal Hospital
General Surgical Consent Form
Owner Name: ________________
Client # ________________
Patient Name: ________________ Breed: __________ Age: ______Sex: _____
Procedure or Surgery Today:______________________________________________
Biopsy - Accept or Decline
Dr. Fred Schneider / Dr. Kristen Endsley
Our greatest concern is the well being of your pet. The doctor will perform a physical examination
before administering anesthetic agents. Anesthesia carries some risk, even though it may be small.
Blackhorse Animal Hospital’s doctors and staff utilize safe anesthetic protocols for all of our patients.
Some patients, due to age, or pre-existing conditions will already have received an estimate that
includes blood work and IV fluids. All patients will receive minimum blood work.
The blood work option below provides a more thorough screening for an additional cost.
Catalyst Chem 17 Clip …………………… …$45.00
Accept or Decline
(All pets will receive IV fluids to maintain blood pressure; reduces post-operative renal failure, and
provides immediate access to heart, should an emergency occurs.)
While your pet is in the clinic, would you like the following additional services performed?
Toe Nail Trim……………………………….…….. $5.00
(Reg. $10.00)
Accept or Decline
Ear Cleaning …..………………………………… $5.00
(Reg. $10.00)
Accept or Decline
Anal Glands……………………………….…….. $5.00
(Reg. $10.00)
Accept or Decline
Microchip ……….……………………………… $40.00
(Reg. $50.00)
Accept or Decline
Fecal Analysis …...………………….………… $20.00
Accept or Decline
Heartworm Test ………………………………. $35.00
Accept or Decline
Does
your
pet
need
any
heartworm
prevention
or
flea
prevention
to
go
home?
________________________________________________________________________________
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