NEWBERG VETERINARY HOSPITAL, P.C.
SURGICAL AUTHORIZATION
Owner's Name:__________________________________Pet:_____________________________
Date_______________________________When last ate?_______________________________
I have been advised of the nature of the services and procedures to be performed,
as well as the risks involved. As the owner or agent of the animal named above, I hereby
give my consent to Newberg Veterinary Hospital, P.C. to perform the
following surgery and/or treatment:
___________________________________________________________________
Signature_______________________________________/phone______________
If my pet is to be spayed and is found to be pregnant, I do NOT wish the procedure
to continue and I understand I will be responsible for the original surgery costs.
Signature_______________________________________/phone_______________
To minimize complications, all animals at Newberg Veterinary Hospital undergoing sedation/anesthesia are
given physical examinations and administered the safest products available. Nevertheless, occasional
problems can arise due to pre-existing conditions not evident during routine pre-surgical examination. To
avoid these problems, we strongly recommend that all surgical cases be screened by means of one or more
of the following pre-anesthetic laboratory tests.
Intravenous catheters are placed in all animals placed under general anesthesia and included in the price
quoted for routine surgical procedures in our hospital. IV catheters are used to adminster fluid therapy to
maintain blood pressure and minimize dehydration during surgical procedures.
Initial for Consent
______
$49.95 Routine pre-surgical blood screen. Tests for
anemia as well as basic kidney and liver function.
General screen for all pets.
______
$60.90 Geriatric blood profile. Complete body function test
and urinary system evaluation. Recommended for
older pets.
______
$48.00 Feline Leukemia/FIV Test (over 6 months of age)
______
Pain Management/analgesic to go home, to keep your pet
more comfortable while recovering from surgery.
Cats are approx.
$28.15
25 lbs – 50 lbs approx.
$15.65
75lbs approx.
$22.55
100 lbs. approx.
$24.15
______
I do not want the above tests performed prior to surgery on my pet.
All animals under General Anesthesia will receive a toenail trim for no charge unless specifically
declined ________ Initial to decline.
All animals having surgery will be provided with an analgesic injection of morphine to make
recovery more comfortable for your pet.
While my pet is anesthetized, I would like the following services performed: (vaccines, microchip
implant, etc.)
_________________________________________________________________Initials__________
Rev. 4/2013