Patient Registration Form

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Spayed / Neutered:
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Owner's Information

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WE DO NOT DO BILLING. PAYMENT IS DUE WHEN SERVICES ARE RENDERED! Thank You.

Animal Hospital of Milan


Surgery Consent Form
PRE-ANAESTHETIC BLOOD SCREENING: We recommend pre-anaesthetic blood screening to help insure the safety of your pet during surgery. These tests screen anemia, liver, and kidney problems, and blood sugar abnormalities. We recommend these test for all pets and especially for older pets and pets with current health problems. Performances of these tests will add a fee of $47.00 to the procedure.
want pre-anaesthetic screening.
PAIN MEDICATION: If the doctor overseeing my pet determines that he/she is experiencing discomfort due to pain after the procedure, I authorize pain medication to be administered. This medication $13.50 519.50 per injection depending on the amount given.
want pain medication if necessary
I am the owner or agent for the owner of the above described animal and have the authority to excuse this consent I hereby consent and authorize the performance of the following procedure(s) or operation(s): I understand that during the performance of the foregoing procedure(s) or operation(s), unforeseen conditions may be revealed that necessitate an extension of the foregoing procedure(s) or operation(s) or different procedure(s) or operation(s) than those set forth above. Therefore, I hereby consent to and authorize that performance of such procedure(s) or operation(s) as are necessary and desirable in the exercise of the veterinarian's professional judgment. I also authorize the use of appropriate anaesthetics, and other medications, and I understand that hospital support personnel wi\I be employed as deemed necessary by the veterinarian. I have been advised as to the nature of the procedure(s) or operations(s) and risks involved. I realize that results cannot be guaranteed. I have read and understand this authorization and consent.
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wish to be called after surgery.