Owner's Name* First Last Pet's Name*Mobile Phone*Work PhoneI understand it is the policy of McGrath Veterinary Center to have my pet current on required vaccinations. Documentation must be provided before or at drop-off. If I am unable to provide documentation, my pet will be vaccinated upon intake and I will be responsible for the associated charges*I understand that my pet's procedure requires general anesthesia and/or sedation and that all precautions will be taken to ensure the safety of my pet. However, I am aware of the possible risks associated with anesthesia or sedation and should any complications arise:Please select one:*I DO authorize the doctor to perform lifesaving efforts/procedures. I also acknowledge that I am responsible for any associated charges.I do NOT wish to to have my pet resuscitatedInitial:*Medical HistoryDid your pet eat this morning?*YesNoHas your pet recently experienced vomiting, coughing, sneezing or diarrhea?*YesNoTo your knowledge, is your pet allergic to any drugs?*YesNoPlease list drugs:*Is your pet currently taking any medication, supplements or vitamins?*YesNoPlease list all medications, supplements and vitamins and the last time they were administered:*McGrath Veterinary Center will perform a complete physical examination prior to anesthetizing your pet. We strongly recommend doing a preoperative blood screening to help evaluate potential anesthetic complications. This may help us rule out conditions such as liver, kidney and certain blood disorders. Would you like blood analysis done?*YesNoWe offer Home Again Microchip Implantation to help reunite you and your pet should he or she become separated from you. Would you like us to place a microchip in your pet today? (Additional charges apply)*YesNoWould you like us to check other problems today or perform any additional procedures? If so, please indicate below:*We recommend taking all personal items with you upon drop off (leashes, collars, etc.) Please be advised we are not responsible for any items that may be lost or damaged.*Would you like your pet's nails trimmed (complimentary)*YesNoDate* Date Format: MM slash DD slash YYYY Signature*