Client Name:

Pet Name:

Client ID:

Pet ID:











Phone Number:




I hereby authorize performance of the following procedures:






     I, the undersigned owner or authorized agent, hereby authorize Edgewood Animal Clinic to perform such medical treatment and/or surgical procedures as are medically indicated, including the administration of such anesthetics as are deemed necessary.  I have been informed that all animals admitted to the hospital must have current vaccinations (Dogs- DHLPP and Rabies;  Cats FVRCP and Rabies) and that these will be administered at my cost should I fail to furnish proof of these vaccinations.   Pets with evidence of flea infestation will be treated at owner’s expense.   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 understand that although an approximate time of release has been given to me that all animals recover from anesthesia at different rates, and that no animal shall be released from the hospital under any circumstances until the doctor feels that it has recovered adequately from the anesthesia.  I understand that I assume financial responsibility for all services rendered, and that payment is due at the time the pet is released from the hospital.  QUOTED COSTS FOR ROUTINE SURGERIES DOES NOT INCLUDE VACCINATIONS, PAIN MEDICATION GIVEN IN HOSPITAL, OR MEDICATION TO GO HOME.  ALL SURGICAL QUOTES ARE ESTIMATES ONLY BASED ON A TYPICAL CASE AND MAY VARY ON INDIVIDUAL ANIMALS.


Method of Payment:

(      ) Cash

(      ) Check

(      ) Mastercard/Visa




Pre-anesthetic mini blood panel  ($35.00)  ______Accept   ______Decline

IV cath/fluid package ($45.00)                   ______Accept  _______Decline

Microchip ID Implant ($38.00)                  ______Accept  _______Decline

Oravet dental sealant with

Home care kit ($40.00)                               ______Accept ________Decline





 Phone number where we may reach you TODAY                Signature of owner or authorized agent/ Date









We offer several services while your pet is hospitalized and/or anesthetized.


PRE OP BLOOD PANEL is a mini screen done in house on the day of the procedure.  It gives us some basic information including a kidney screen, blood glucose, PCV (check for anemia) and total protein.  This can help us to identify risk factors not apparent on physical exam which might cause us to alter or delay our procedure.  It is recommended but not required for all pets.  In some instances, your pet’s individual status will cause our doctor to recommend or require a full blood panel to be sent out to our lab prior to the procedure;  this needs to be done at least one day prior to the procedure and in most cases will have been addressed before the procedure date.


IV CATHETER/FLUID PACKAGE is highly recommended for older pets undergoing anesthetic (most commonly dental procedures) and is recommended for younger pets especially when undergoing longer or more invasive procedures.  Having an IV in place and fluids running helps to protect the kidneys from unexpected drops in blood pressure which may affect function, and also provides a quick access for IV medication in case of emergency.  In some cases the doctor may require this option due to the pet’s age, health issues, or the nature of the procedure.  In general the IV cath package is not recommended for cat neuters due to the short length of the procedure.


MICROCHIP ID IMPLANTATION is a service we offer at any time but many owners prefer to have done while the pet is sedated.  The microchip serves as a permanent, legal ID should your pet become lost.  Registration with HomeAgain database registry is needed at an additional charge.  If your pet was adopted from a local shelter, please let us know prior to requesting this service as they may already have had a chip implant.


ORAVET DENTAL SEALANT AND HOME CARE KIT is provided primarily as a service during our dental procedures (but is also an option for any pet during sedation for other procedures provided their teeth are clean and free of calculus at the time of application).  The dental sealant helps to prevent tartar accumulation on the teeth.  After the initial application in the hospital, a take home kit is provided with an 8 week supply of gel.  Simple quick weekly applications help to keep tartar accumulation down and prolong the interval between professional cleanings.  This can be especially valuable for pets who tend to re-accumulate tartar and calculus quickly, and can be useful if applied during spay/neuter procedures as the beginning of a dental care program.