Owner's Name*

First Last

Pet's Name*

Mobile Phone*

Work Phone

I 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 resuscitated

Initial:*

Medical History

Did your pet eat this morning?*

Yes
No

Has your pet recently experienced vomiting, coughing, sneezing or diarrhea?*

Yes
No

To your knowledge, is your pet allergic to any drugs?*

Yes
No

Please list drugs:*

Is your pet currently taking any medication, supplements or vitamins?*

Yes
No

Please 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?*

Yes
No

We 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)*

Yes
No

Would 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)*

Yes
No

Date*

Signature*