Skip to content
253-588-1851
253-201-6645
Online Pharmacy
Careers
hours
location
RX
Careers
COVID-19 Updates
Today:
8:00 am - 6:00 pm
Open Hours
253-588-1851
Phone Number
11419 Bridgeport Way SW
Lakewood, WA, 98499
Home
Our Practice
Services
Contact Us
Online Pharmacy
Paws & Read
Pet Corner
New Patient Form
Pet Health Records
Request a Refill
Payment Options
Request an Appointment
processingbanners
Surgical and Anesthetic Admission Form
Fill out the fields below to share your pet’s history.
Your Name
*
Authorized Person Bringing Pet in for Procedure:
Patient Name
*
Date of Procedure
*
Contact phone number for day of procedure?
*
Your Email
*
Have you or anyone in your household tested positive for Covid-19 in the last 14 days or been exposed to someone who has?
*
Have you experienced unexplained coughing, fever, aching, loss of sense of smell or taste, and/or sore throat, in the past 14 days?
*
Are we using a credit card that is already on file to pay for the visit (if not, please call our office to provide your credit card information)?
*
All patients who undergo anesthesia will receive a physical examination with a doctor prior to anesthesia. Please describe any specific problems that you would like us to evaluate:
Blood work is required within 6 months for all patients undergoing anesthesia (Or sooner for some conditions). IV Catheter and Fluids are required for all patients undergoing general anesthesia. A small area on either front leg will be shaved for placement of the IV catheter. A monitoring device, which may require shaving a small area on the underside of the tail for placement of the pulse oximeter to help monitor your pet’s heart rate and oxygenation while under anesthesia. All of these items will be included in your pet’s care plan in the doctor’s direction. Please ask to see the care plan if it is not brought out to you. Initial to indicate Understanding and Consent:
*
An Elizabethan Collar (yes, the cone of shame!) is recommended after surgery to prevent your pet from licking/chewing/damaging the incision. If damage occurs, and surgical repair is needed, this will be an extra expense. An e-collar may be purchased on the day of the procedure. Please select YES or NO for having the e-collar added to your invoice on the day of the procedure.
*
Yes
No
For Sterilization procedures ONLY, a green linear tattoo can be made to identify your pet as sterilized, unless requested otherwise on this form. Please authorize by selecting YES or decline by typing NO:
*
Yes
No
I understand, and accept, when anesthesia is involved there are always inherent risks, including death, and no guarantee has been expressed or implied regarding complications or outcome. Furthermore, in the event of an emergency, I authorize doctors and staff of this facility to perform any procedures deemed necessary until further communication with me. I will not hold the doctors or staff liable for any complications. I certify that I understand this release, and the procedure/s have been explained to my satisfaction and I assume full financial responsibility of charges accrued. Please type your full name to sign this form:
*
Close
Font Resize
A-
A+
Keyboard navigation
Readable Font
Underline links
Highlight Links
Clear cookies
Images Greyscale
Invert Colors
Close
Accessibility by WAH