Testing General Consent Form Pampered Pets Veterinary Clinic and Spa J. Brian Ledger, DVMClient:Patient Name/ID:Phone:Breed – Species:Doctor: J. Brian Ledger, DVMAge:Date Date Format: MM slash DD slash YYYY Sex:General Consent Form What method of communication would you prefer: Text:Phone:Email: Procedure(s):Other : SpecifyWould you like your pet to receive a microchip?YesNoRisk associated with not using an Elizabethan (e-collar) Collar: Elizabethan Collars (e-collars) are used as a tool to help pets heal quickly and safely after medical/surgical procedures. A dogs/cats nature is to lick and bite areas of discomfort, which can lead to infection or opening of the surgical incision. While it may appear an inconvenience to leave this on for the duration of the recovery, it is medically required for proper healing. Consent for Treatment or Surgery: I hereby authorize and direct the veterinarian of Pampered Pets Veterinary Clinic & Spa to perform the above described procedure(s). The nature and purpose of the procedure(s) has been explained to me and I understand that no guarantee exists as to the result of diagnosis and treatment of the said animal. I agree to pay, in full, for services rendered, including those deemed necessary for medical or surgical complications or unforeseen circumstances. If unforeseen conditions arise, in the judgement of the attending veterinarian, call for procedures or treatments other than those now being authorized. I authorize such procedures if reasonable efforts to contact me for further consent are unsuccessful. I understand that while the anesthetic used in this hospital is one of the safest used in veterinary medicine, NO anesthesia is without medical risks. No guarantee can be made legally, or ethically to me on the outcome of any procedure performed. I have read and understand this consent. I herby certify that I am over the age of 18 and the owner or decision maker of the above-named animal and have the authority to execute this consent.SignatureDate Date Format: MM slash DD slash YYYY CAPTCHA This iframe contains the logic required to handle Ajax powered Gravity Forms. Dental Consent Form Pampered Pets Veterinary Clinic and Spa J. Brian Ledger, DVMClient:Patient Name/ID:Phone:Breed – Species:Doctor: J. Brian Ledger, DVMAge:Date Date Format: MM slash DD slash YYYY Sex:Dental Consent Form All surgical procedures require a basic lab panel be done prior to any surgery. Expanded lab panel may be required due to any prior illness or age. Yes, need labYes, would like extended labNo, current on labdate of last labAll food and water need to be pulled no later than 10pm the night before the procedure. Drop off times are in between 7 and 9 am, and pick up is in between 4 and 4:30 Phone Number:Are there any times you cannot be reached?YesNoPerson dropping off the petRelation to the petWhat method of communication would you prefer: Text or Phone call?Procedure(s):Would you like your pet to receive a microchip:YesNoDental cleaningOther:Dental Extractions: It is difficult to fully examine a pet’s teeth without sedation. Therefore, there may be a possibility that your pet will need extractions. If this is the case, all possible steps will be taken to get into contact with you during the surgery. If we are unable to reach you, no extractions will be performed, and they will need to be done at a later date. Extractions can cost $35-$395 per tooth depending on the tooth and its disease status. Consent for Treatment or Surgery: I hereby authorize and direct the veterinarian of Pampered Pets Veterinary Clinic & Spa to perform the above described procedure(s). The nature and purpose of the procedure(s) has been explained to me and I understand that no guarantee exists as to the result of diagnosis and treatment of the said animal. I agree to pay, in full, for services rendered, including those deemed necessary for medical or surgical complications or unforeseen circumstances. If unforeseen conditions arise, in the judgement of the attending veterinarian, call for procedures or treatments other than those now being authorized. I authorize such procedures if reasonable efforts to contact me for further consent are unsuccessful. I understand that while the anesthetic used in this hospital is one of the safest used in veterinary medicine, NO anesthesia is without medical risks. No guarantee can be made legally, or ethically to me on the outcome of any procedure performed. I have read and understand this consentI hereby certify that I am over the age of 18 and the owner or decision maker of the above named animal and have the authority to execute this consent.CAPTCHA This iframe contains the logic required to handle Ajax powered Gravity Forms. Boarding Drop Off Form Pampered Pets Veterinary Clinic and Spa J. Brian Ledger, DVM 805 W. Covell Road, Suite 700 Edmond, Ok 73003, 405-340-8387Client:Patient Name/ID:Phone:Breed – Species:Cage:Age:Arrival Date: Date Format: MM slash DD slash YYYY Sex:Departure Date: Date Format: MM slash DD slash YYYY Current Weight:All pets must be current on monthly prevention and have a current fecal and heartworm test on file. If not current the tests and prevention will be done at the clinic at the owner’s cost. If any parasites are found on pet while boarding, we will require a dose of prevention to be applied to the pet. We accommodate and welcome special needs pets. However, their may be additional charges for pets that need one on one care.Name of Veterinary Quality Flea and Tick Prevention:Name of Veterinary Quality Heartworm Prevention:What is the date the prevention was last applied?:Is there any medical history we should be aware ofIs your pet on any medication? If yes, list below:All medication must be brought in their original bottles, and a dispensing fee will be added to their reservation. Medical care will be given to pets that require medical attention while boarding. We will contact you by your preferred method to discuss treatment. Dr. Ledger will do basic treatment for the pet’s welfare at the owners expense until we are able to reach you. If you agree ahead of time you can request whatever treatment necessary if we are not able to contact you. I agree to do basic treatment of my pet until I can be contactedI agree to do whatever treatment necessary even if I cannot be contacted*If major medical need arises all patients will be transported to Blue Pearl Veterinary Emergency and Critical Care Hospital for treatment at the owners expense.Is your pet social with other pets and people?YesNoWill your pet be eating our stomach sensitive food or their own food:ClinicOwnHow much and how often do they eat:Has your pet already ate today:Has your pet already ate today:Special food or treat instructions:*Extra charges may be added to special feeding requests. (feeding separate, longer preparation, storage fees) Bath and Spa Services:All lodging guests receive a discounted bathing price depending on the length of stay at PPVC. 1-3 Nights - $25 for bath, brush and blow dry. 4-7 Nights - $18 for bath, brush and blow dry. 8-12 Nights - $15 for bath, brush and blow dry Clinic bath and prices depend on size of pet and length of coat. Grooming prices depend on size of pet, length and condition of coat, and temperament of pet Would you like your pet to receive a boarder bath, clinic bath or grooming services:Date Date Format: MM slash DD slash YYYY Perferred name and method of contact:PhoneText:Email Emergency contact name and number:All boarding related concerns must be discussed with PPVC management within 24 hours after check-out. Owner agrees to pay the rate for lodging and additional guest services requested prior to discharge. PPVC does offer medical services for the pets during their stay if not past due on vaccines. Bedding will be provided for your pets stay. If you would like to bring their own personal belongings, Pampered Pets will not be responsible for any lost or damaged items.CAPTCHA This iframe contains the logic required to handle Ajax powered Gravity Forms. Neuter Consent Form Pampered Pets Veterinary Clinic and Spa J. Brian Ledger, DVMClient:Patient Name:Phone:Breed – Species:Doctor: J. Brian Ledger, DVMAge:Date Date Format: MM slash DD slash YYYY Sex:Neuter Consent Form All surgical procedures require a basic lab panel be done prior to any surgery. Expanded lab panel may be required due to any prior illness or age.Yes, need labYes, would like extended labNo, current on labDate Date Format: MM slash DD slash YYYY All food and water need to be pulled no later than 10pm the night before the procedure. Drop off times are in between 7 and 9 am Pick up times are in between 4 and 4:30 PM Phone number and name of the person responsible for the pet:Any times you cannot be reached during 9 and 2? How would you like to be contacted? PhoneText:Email Procedure(s):NeuterSpayRes-Q MicrochipWould you like your pet to receive a microchip? Has Microchip Risk associated with not using an Elizabethan (e-collar) Collar: Elizabethan Collars (e-collars) are used as a tool to help pets heal quickly and safely after medical/surgical procedures. A dogs/cats nature is to lick and bite areas of discomfort, which can lead to infection or opening of the surgical incision. While it may appear an inconvenience to leave this on for the duration of the recovery, it is medically required for proper healing. Consent for Treatment or Surgery: I hereby authorize and direct the veterinarian of Pampered Pets Veterinary Clinic & Spa to perform the above described procedure(s). The nature and purpose of the procedure(s) has been explained to me and I understand that no guarantee exists as to the result of diagnosis and treatment of the said animal. I agree to pay, in full, for services rendered, including those deemed necessary for medical or surgical complications or unforeseen circumstances. If unforeseen conditions arise, in the judgement of the attending veterinarian, call for procedures or treatments other than those now being authorized. I authorize such procedures if reasonable efforts to contact me for further consent are unsuccessful. I understand that while the anesthetic used in this hospital is one of the safest used in veterinary medicine, NO nesthesia is without medical risks. No guarantee can be made legally, or ethically to me on the outcome of any procedure performed. I have read and understand this consent.I hereby certify that I am over the age of 18 and the owner or decision maker of the above named animal and have the authority to execute this consent. CAPTCHA This iframe contains the logic required to handle Ajax powered Gravity Forms.
