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Items marked with an * are required to be filled out to submit the form. |
| Pet's name * |
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| Breed * |
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I certify that I own the above described animal, and do hereby consent and authorize Doctors T.E. Ritchie, R.C. Riggs, C.A. Latimer, J.L. Coate or their associates to care for my pet.
I understand that risks exist with the use of medications, testing procedures, anesthesia, and surgery.
I am encouraged to discuss any concerns that I have about the procedures(s) and risks involved and I also understand results cannot be guaranteed.
Payments: I am aware that unforeseen events resulting from the procedure(s) will not relieve me from any obligation to all reasonable costs incurred.
Furthermore, all fees due for the care and treatment of my pet will be paid in full the day that my pet is discharged from the hospital. In the event that I fail to pay these fees,
I will be liable for the reasonable costs of collection, including court costs and attorneys fees.
Please accept by typing your initials: |
Preanesthetic Bloodwork: This is an in-house blood screening to test liver and kidney values. It helps us to determine if your pet is a good candidate for anesthesia. There is an additional cost for this service.
OPTIONAL for pets under 7 years old
This bloodwork is
REQUIRED for the health and safety of pets 7 years and older
Yes No (please check one to select your choice) more information |
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Dental Patients: During a dental cleaning, it may be necessary to take dental x-rays or extract teeth. Would you like to give approval now or be called while your pet is under anesthesia with an estimate
of any additional procedures?
Please call for approval
Please call for anything over estimate (recommended)
Approval received at drop-off
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FIV/Feline Leukemia/Heartworm Testing: This is recommended for all cats that have not yet been tested or any cat that goes outside, has had cat bite wounds, or is acting sick.
There is an additional charge for this test.
Yes No (please check one to select your choice) |
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Other Services: We can provide these additional services while your pet is under anesthesia for an additional cost. Please select the services you would like performed today.
Nail Trim ($17.00)
Anal Gland Expression more information
Microchip Placed more information |
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Estimate: Would you like an estimate of your pets charges for today?
Yes No (please check one to select your choice)
I have received an estimate
I would like to be called with an estimate |
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Vaccination: All pets must be current on vaccinations for entry to the Best Friends pet hospital. By submitting this form I agree that my pet is
fully vaccinated. If vaccinations were performed by someone other than Best Friends, I will provide records of vaccination.
If my pet isn't up to date on vaccinations, Best Friends will need to vaccinate my pet for it to be admitted to the hospital. I understand there is an additional charge for
this service. Best Friends will gladly provide
me with an estimate with the costs if desired.
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I hereby acknowledge that I have read and agree to the above terms and conditions. *
Please type your full name here to accept: Date: 5/23/2013
Contact Information where we can reach you today
WHILE YOUR PET IS UNDER ANESTHESIA if necessary: |
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| Name:* |
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| Primary Number:* |
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| Name: |
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| Alternate Number: |
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| Name: |
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| Alternate Number: |
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| Please enter at least one phone number and contact name. * |
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Click Submit to send this form to Best Friends Veterinary Hospital staff. Please make sure to fill
in your appointment date.
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