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. *

Has Your Pet Had Access To Food Or Water?

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

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

CBC & PROFILE & PT/PTT, $126.50 *

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

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 *

Date *

Dogs

Cats

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

Dogs

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

Cats

General Surgery Consent Form

Schedule An Appointment Today!