Patient Information

Owner Name *

First

Last

Pet's Name *

Age

Date of Birth

If Known

Gender *

Weight (lbs)

Email *

example@example.com

Phone Number *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Health Insurance (if applicable)

Insurance Policy ID

Emergency Contact Details

Contact Person Name *

First

Last

Primary Phone Number *

Secondary Phone Number

Authorized Person for Pick-Up (other than owner(s))

First

Last

Medical Data

Name of Procedure or Treatment to be performed:

(ex. Spay/Neuter, Dental, Foreign Body Surgery, Sedated Xrays, etc.)

Does your pet have any known allergies? If yes, then please specify below.

Is your pet currently taking medications? If yes, then please list the medications and the reasons why they are taking them.

Is your pet fully vaccinated and up to date? If no, please list which ones are needed.

Acknowledgment, Authorization and Waiver

Please read: *

By signing your name, you acknowledge you have read and understand the above *

First

Last

Date Signed *

Laser Therapy Consent Form

As part of our commitment to quality care, we are pleased to offer laser therapy as a safe & comfortable treatment option for your pet. We feel that laser therapy provides the best possible care for your pet.

The benefits of laser therapy are:

LESS PAIN - Laser therapy has a high beneficial effect on nerve cells which block pain transmitted by these cells to the brain and which decrease nerve sensitivity.
LESS BLEEDING - Laser beams will significantly increase the formation of new capillaries in damaged tissue that speeds up the healing process, closes wounds quickly, and reduces scar tissue.
LESS INFLAMMATION - Laser therapy has an anti-edema effect as it causes vasodilatation, but also because it activates the lymphatic drainage system (drains swollen areas). As a result, there is a reduction in swelling caused by bruising or inflammation from surgery.

Laser therapy can reduce your pet's post-operative recovery time, leading to a quicker return to normal activities.

Please choose the level for your pet coinciding with the surgical procedure he or she may be having.

LEVEL 1 - $55 (spays, neuters, minor skin lesions such as warts, etc.)
LEVEL 2 - $65 (oral surgery, eyelid repair, etc)
LEVEL 3 - $160 (dermatitis, arthritic sessions, etc.)

Medical Consent Form

Anesthesia/Surgical Consent Form

Patient Information

Emergency Contact Details

Medical Data

Acknowledgment, Authorization and Waiver

Laser Therapy Consent Form

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