Surgery and Dental Intake Form

Your name *

First Name

Last Name

Phone number to best reach you today *

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Secondary Phone Number

(###)

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Please confirm that your pet has been fasted 12 hours before arrival. (This means food has been with held for 12 hour prior. Water is an exception and can be offered at all times)

Yes

No

Please confirm that we have gone over the procedure, the benefits, and the risks along with the estimated costs. *

Yes

No

Please confirm that you picked up the pre-surgery oral sedative medication (Gabapentin or Trazodone). *

Yes

No (If no, please pick up anytime possible before surgery date.)

If applicable (Neuter and Spay procedures), please indicate if you would like a microchip for your pet. This has a cost of $105.00.

Yes

No