Town and Country Animal Hospital 1001 Schippel Drive Salina, KS 67401 (785)823-2217 www.tcvets.com
Date _____________ Owner’s Name ____________________________ Pet’s Name __________________________
Procedure: _______________________________________________________________________________________
Please review the following information carefully to ensure you understand our recommendations.
I have reviewed the information about pre-anesthetic blood work that has been provided and would like you
to perform the following recommended test: Kittens <1 year of age (CBC), Adults 1-6 years of age (CBC & Pre-Surgical
Profile), Mature Adults >6 years of age (CBC, Chemistry Profile & Thyroid Test)
Complete Blood Count (CBC) ($33.57)
□ Recommended
□ Included
Pre-Surgical Profile ($55.30)
□ Recommended
w/CBC ($59.69)
□ Recommended
Chemistry Profile ($93.49)
□ Recommended
w/CBC ($100.86)
□ Recommended
Thyroid Test ($48.66)
□ Recommended
□ I accept the recommended blood work. □ I decline the recommended blood work.
Our Comfort Package is a wonderful way to help minimize the discomfort your pet will feel due to the
procedure. While undergoing and after surgery, your pet will receive a pain management injection. Along
with the additional pain medication your pet will also receive a laser therapy treatment which uses a beam of
laser light to penetrate tissue, which leads to reduced pain, reduced inflammation and an increase healing
speed. Comfort Package ($25.00)
□ I accept
□ I decline
We are pleased to offer laser surgery as an option for safe, comfortable treatment for your pet. There are
several benefits of laser surgery. Less Pain – the laser seals nerve endings as it “cuts”, so your pet may require
fewer anesthetics during the operation, also reducing pain after the surgery. Less Bleeding – the laser seals
small blood vessels during the surgery, greatly reducing blood loss. Less Swelling – the laser energy does not
crush, tear, or bruise the tissue because there is no physical contact with the tissue. This can reduce your pet’s
post-operative recovery time, leading to a quicker recovery and return to normal activities.
Surgical Laser ($41.00) w/Declawing ($51.00)
□ I accept
□ I decline
Feline immunodeficiency virus (FIV) and leukemia (FeLV) infections are major causes of illness and death in
cats. Both viruses are contagious, spread easily from cat to cat. Early detection of infection will help you not
only to maintain the health of your own cat, but also allow you to prevent spreading infection to other cats.
Our FIV/Felv tests also include a heartworm test because heartworm disease in cats is more common than
once believed. FIV, FeLV & Heartworm Test ($38.78) □ I accept □ I decline □ My cat has been tested.
Intestinal parasites, such as roundworms and hookworms are infectious to people. Often times it is difficult
for you to collect a fresh stool sample and bring it to our clinic. If your pet defecates while at the clinic, would
you like us to test it for parasites?
Fecal ($18.55) □ I accept □ I decline □ My pet has had a fecal test performed within the last year.
A microchip is the best form of identification because it is permanent. A microchip can be implanted at any
time. Home Again Microchip ($41.00)
□ I accept
□ I decline
□ My pet already has a microchip.
If needed, IV Catheter/Fluid Therapy will keep your pet hydrated during the procedure, and will compensate
for any blood loss. Fluids also help maintain adequate blood pressure, and the catheter gives us venous access
in case your pet should need any IV medications. Also it can be the difference between life and death in the
case of a complication. IV Catheter/Fluid Therapy ($67.00)
□ I accept
□ I decline
Feline Surgical Consent Form
Town and Country Animal Hospital 1001 Schippel Drive Salina, KS 67401 (785)823-2217 www.tcvets.com
Misc Services Available:
Declawing (Front Only)
□ I accept
□ I decline
Pain Management Injection Only (Minimum $18.50) □ I accept
□ I decline
W/Mass Removal – Histopathology ($92.00) □ I accept
□ I decline
Pedicure □ I accept (Complimentary)
Ear Cleaning □ I accept ($12.00)
Vaccinations:
FVRCP-C is a four in one vaccine that includes protection against panleukopenia or distemper, viral
rhinotracheitis, calicivirus and pneumonitis. Leukemia is a vaccine that protects against feline leukemia
which is a viral disease. Before vaccinating your pet for leukemia we recommend testing. These vaccines are
recommended yearly and some may require additional boosters to maintain a full year of protection. Rabies is
given every two years after the initial vaccine, which is only current for one year. In the state of Kansas the
rabies vaccine is a legal requirement. If you live within the city limits you are required to have a city license
for your pet.
After reviewing the information please perform the following vaccines.
Rabies ($19.50) (REQUIRED VACCINE)
□ I accept
□ Current (Proof Required)
FVRCP-C ($40.70)
□ I accept
□ I decline
□ Current
Leukemia ($26.40)
□ I accept
□ I decline
□ Current
ALL ANIMALS ADMITTED MUST BE CURRENT ON THEIR RABIES VACCINE AND MUST BE FREE OF
EXTERNAL PARASITES. ANY ANIMAL FOUND TO HAVE FLEAS OR TICKS WILL BE TREATED AT THE
OWNER’S EXPENSE.
Your pet will be undergoing general anesthesia today. I understand that with any anesthesia and/or surgical
procedure there is a possibility of complications.
Signature _________________________________________________________ Date:
Phone # that you can be reached at? _________________________________________________
Feline Surgical Consent Form