I authorize and direct Dr. McPherson, Dr. Fullenwider, Dr. Blossey and/or Dr. Taylor of
Tuscawilla Oaks Animal Hospital to perform diagnostic, treatment and surgical procedures as deemed advisable or necessary for my pet.
The nature of the procedure has been explained to me and no guarantee has been made as to the results or cure. I fully understand that there may be a risk to such procedures. I agree to pay, in full, for the services rendered, including those deemed necessary for medical or surgical complications or otherwise unforeseen circumstances. Any estimate of charges or fees for presently planned procedures is only an approximation, and the final bill may be less or greater than this amount.
A complete physical examination and pre-operative bloodwork panel will be performed prior to anesthesia. While these measures help reduce the risk of anesthetic and/or surgical complications, I understand that there are risks associated with these procedures, including risk of permanent disability or death.
I have read and acknowledge the above conditions of this clinic and have received a copy of this form, if requested.
Patient Name
:_________________________________________
Date
:________________
EMERGENCY CONTACT# : ___________________________
SIGNATURE
: ______________________________________________
Would you like to receive text message updates? Yes __________ No ____________
Cell phone number: _____________________
If so, mark your carrier: ____ AT&T ____Verizon ____ T-mobile ____Sprint ____Alltel
____Boost ____Virgin ____Metro PCS
We are proud to introduce a permanent identification system, which is being used throughout the country.
If your pet is lost or stolen, this system can notify you if your pet is picked up anywhere in the country.
This service costs $43.00 (including the first year registration fee) and is applied under the skin. Ask for details.
K-laser therapy is a drug free and pain free option to help decrease inflammation and help with post surgical recovery. While recommended for all patients, we are requiring this treatment for all orthopedic surgeries.
A technician will go over all details prior to leaving your pet in our care. The cost for this treatment ranges between $19.00 and $28.00.
Yes , I would like to get the k-laser treatment for my pet: __________________________
No , I would like to decline this service today. __________________________________