Please read carefully and fill out the form completely.

AUTHORIZATION FOR PROFESSIONAL SERVICES

Address
I hereby authorize the following surgical procedure to be performed by Doctor Connelly:

The nature of such service has been described to me to my satisfaction and I realize that no guarantee or warranty can ethically or professionally be made regarding the results or cure. I also understand that I assume financial responsibility for all services rendered, and that payment is due upon dismissal of my pet.
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Before putting your pet under anesthesia, we will perform a full physical exam. However, many conditions such as liver, kidney, or blood disorders cannot be detected unless a blood test is performed. This testing is mandatory for all pets prior to any surgical procedures. For pets under 1 year of age the cost is $53.00. More comprehensive testing is required for pets over 1 year of age, and the cost is $77.00. Our lab is fully equipped to give results immediately, before any anesthesia or surgery is performed. By signing below you consent to these diagnostics for your pet.
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POST SURGERY PAIN MANAGEMENT

For Dogs:
For Cats:

POST SURGERY INCISION CARE- CHECK ALL THAT APPLY

(Does not apply to Teeth Cleanings)
POST SURGERY INCISION CARE- CHECK ALL THAT APPLY
***E-COLLARS, POST SURGICAL SUITS, AND SEDATIVES ***
ARE AT AN ADDITIONAL COST
Microchipping is a method of permanently identifying your pet. If they become lost or stolen, an animal with a microchip can be positively identified and returned to their owner even if they have lost their collar. The cost is $52.00
*Any pets found to have fleas will be treated at owner’s expense.