Our Pet Surgery Admission Form Ensures Your Companion’s Health And Safety During The Operation

Franklin Veterinary Associates

Hospital Admission Form

Note: If you are able to give medications without using food, please give morning dose on the day of your pet’s procedure

(If unable to give medication w/out food – please bring medication with you)

I understand that if my pet has evidence of external parasites (fleas, ticks, ear mites, lice, etc.), Franklin Veterinary Associates will treat them with an appropriate product, and I will be charged for that treatment.

I further understand that during the performance of these procedures, unforeseen condition may cause additional procedure(s) than set forth above.  I expect FVA to use reasonable judgment in performing the procedure(s).  I am aware that unforeseen events will not relieve me from any obligation to all reasonable costs incurred regarding the animal.  I understand that payment in full is expected when services are rendered.  I also understand that FVA does not provide 24 hour supervision.

Electronic signature will be requested at time of admission.

Please vaccinate my pet for the following (check your choices)

LABORATORY TEST WAVIER

If your pet is to be anesthetized, rest assured that advances in anesthesia and surgery have made routine procedures relatively safe with a low rate of complications.  Nevertheless, occasional problems can arise due to pre-existing conditions not evident during routine pre-anesthetic examinations.  To reduce the chances of these problems occurring, we recommend that all these cases be screened prior to anesthesia by means of the following test(s).  Note: Animals 7 years and older are required to have a pre-surgical profile before their procedure.