Owner’s Name *

First

Last

Pet’s Name *

Today’s Phone *

I consent to receive SMS text messages from Lazy 3 Animal Care. Msg & data rates may apply. Reply STOP to opt-out. *

Yes
No

Has Your Pet Had Access To Food Or Water?

Yes
No

Preanesthetic Bloodwork (Dr. Recommended, to determine any underlying disease that might add risk to your pet’s procedure, i.e., low red blood cell/platelets, white blood cell abnormalities, blood sugar abnormalities, liver or kidney function, any which could lead to serious adverse reaction to the surgery, anesthesia, or healing process.)

CBC & PT/PTT (important for surgery patients; check clotting times & blood cell count), $71.50 *

Yes
No

CBC & Profile (checks organ function & blood cell count), $66.00 *

Yes
No

CBC & PROFILE & PT/PTT, $126.50 *

Yes
No

Thyroid Screening (hair loss &/or unexplained weight gain), $45.10 *

Yes
No

Owner would like pain medication to keep pet comfortable after surgery (please initial, additional cost)

Important, does your pet display any of the following? (Select all that apply.)

***** Please feel free to request a consultation with one of the doctors or technicians to answer any questions or concerns.

Other *

Extras while anesthesized (Select all that apply.)

(Cost varies)

Other *

Anesthesia & Surgery Consent *

I do hereby authorize Lazy 3 Animal Care to perform a surgical procedure requiring general anesthesia on my animal. I am aware of the risks involved and responsibilities arising from anesthesia and surgery. I am also aware that not all surgeries are routine due to individual animal differences. I understand additional fees may apply for surgical supplies if my animal is obese or deep-chested.

Signature of owner / Responsible party *

Clear Signature

Date *

Vaccines Requested

Dogs

DHLPP (distemper, infectious hepatitis, lepto, parvo, canine influenza) $41.00
Rabies $21.00
Kennel Cough $33.00
Rattlesnake $40.00

Cats

FVRCP + LEUK (herpes virus, respiratory virus, feline distemper + feline leukemia) $40.00
Rabies $21.00

Disease Screening

Dogs

Heartworm Test (a yearly heartworm test is REQUIRED to purchase Heartworm Preventative) $52.25
Heartworm & Tick-borne disease test $58.85

Cats

Feline Leukemia/FIV/Heartworm Test Combo $57.75

General Surgery Consent Form