Please read carefully and fill out the form completely. AUTHORIZATION FOR PROFESSIONAL SERVICESOwner’s Name Pet’s Name Breed: Age: Sex Address Street Address City State / Province / Region ZIP / Postal Code Daytime Phone#Evening Phone#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. Signature of ClientDate MM slash DD slash YYYY 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 $51.00. More comprehensive testing is required for pets over 1 year of age, and the cost is $74.00. 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.SignatureDate MM slash DD slash YYYY POST SURGERY PAIN MANAGEMENT For Dogs: Yes, I would like additional pain medication for my dog after surgery. If needed. Please send home pain medication for my pet if the doctor recommends it. For Cats: Yes, I would like additional pain medication for my cat after surgery. (Required for declaw surgeries) If needed. Please send home pain medication for my pet if the doctor recommends it. POST SURGERY INCISION CARE- CHECK ALL THAT APPLY (Does not apply to Teeth Cleanings) POST SURGERY INCISION CARE- CHECK ALL THAT APPLY I would like my pet fitted for a Traditional E-Collar (“cone of shame,” “lampshade,” etc.) I would like my pet fitted for an Inflatable E-Collar (the “donut”) I would like my pet fitted for a Post-Surgical Suit I would like the Doctor to prescribe a sedative to help calm my pet while they are healing. I decline all of the above ***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 $49.00 Yes, I would like to have a microchip inserted in my pet. No, I am not interested in this pet retrieval offer. My pet is already micro chipped. *Any pets found to have fleas will be treated at owner’s expense.