Client Information

Client Name*
Client Address*


The lack of response on any service option will indicate that service is to be performed

I am the owner (or agent) of the above-name pet, and am not a Minor. I authorize and request you to hospitalize this pet for the purpose of diagnosis, treatment, or surgery procedures, and approve the use of whatever anesthetics you deem advisable for the well-being of the above-named pet. I understand that you will use responsible precautions to assure the animal's safety while in your care, but will not hold you responsible, and I absolve you of all liability arising from the performance of procedures requested herein.

I agree to pay for all services described and to pay for the services rendered due to medical/surgical complications, or unforeseen circumstances. I am aware that there is NO CREDIT. Direct payment will be made to. There may be additional charges if all tests and procedures have not been entered. These charges will be billed by mail and payment is expected within 30 days of billing. There will be an additional 1.5% finance charge (minimum of $1.00) added per month on the balance due. A $38.00 collection fee will be added to any balance sent to our collection service.

If your pet is admitted to the hospital with fleas, the staff will treat your pet with a monthly topical flea preventative for an additional charge.

Treatments (i.e. bandages and medications), X-ray, and laboratory procedures rendered after the patient has been released from the hospital are not included in the cost of fees charged for the original episode and will be paid for as separate episodes.

Pre-Anesthetic Blood Testing - Consent Waiver

Like you, our greatest concern is the well-being of your pet. Before putting your pet under anesthesia, we prefer to perform a full blood analysis. Blood chemistry tests give us an inside look at your pet's vital organs and lets us know if they are functioning normally. Such tests are especially important before any kind of surgery.

An aging pet's organs will deteriorate, and may lose their ability to function properly. Routine preventive testing for early detection allows us to help live a longer, healthier, happier life. The tests give us a look at 's overall health status, from liver to kidney levels. Just because your pet may be young or look healthy, does not mean that the organs are functioning properly.

These tests are recommended on ALL pets and are HIGHLY RECOMMENDED on pets 6 years and older.*

Post-Operative Pain Medication

Pain medication is often given to our hospitalized patient immediately following a surgical procedure. While many pets exhibit minimal discomfort following surgery, we find that additional pain medication in the days following surgery can often be beneficial in the recovery process. The strength and duration of the medication will vary depending upon the procedure and our assessment of the individual's needs.

Elizabethan Collar (E-collar)

If applicable, an e-collar will be sent home with your pet after surgery. E-collars help prevent your pet from reaching their surgery incision which can prevent additional post-op problems and costs such as incision repair. At your own discretion, you can choose not to use it or use a different kind of collar, however one from the clinic will be sent home.


Additional Services

Microchip: Microchipping is the latest form of permanent identification and is done by injecting the chip with a syringe. A large needle is needed, but the procedure is painless and convenient under general anesthesia.

Topical Fluoride Treatment for Teeth: Fluoride treatment of your pet's teeth at the time of spaying/neutering (the pet must be at least 6 month old) can give permanent benefits from hardening of the tooth enamel and in older pets can increase resistance to tooth decay and decrease dentinal sensitivity. If there are any retained baby teeth that will cause a problem in the future, we will extract them while your pet is under anesthesia.

Do you want your pet to be microchipped?*
Do you want your pet to receive topical fluoride treatment?*
If your pet is here for a growth removal, do you want a biopsy done at an additional charge?*
If your pet is here for a bladder stone removal, do you want a stone analysis done at an additional charge?*
For 's your pet’s health, vaccines should be current. Pennsylvania State Law requires that all dogs and cats older than 3 months of age be current on Rabies vaccine.
For 's your pet’s health, vaccines should be current. Pennsylvania State Law requires that all dogs and cats older than 3 months of age be current on Rabies vaccine.
Is your pet current on the rabies vaccination? If not, we will vaccinate your pet for rabies while here for surgery. If your pet was vaccinated elsewhere we will need to see a rabies certificate.*
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Would you like your pet to be updated on all recommend yearly vaccines?*
Would you like your dog tested for 4DX Snap Test (4DX - Heartworm / Tick Borne Diseases) while here?*
Would you like your cat tested for Felv/Fiv while here?*

Dental Consent

The doctors at Hidden Valley Animal Clinic will do everything possible to preserve and maintain the health of your pet’s teeth. During the course of the examination and cleaning, loose or decayed teeth may be found. Unhealthy and decaying teeth can lead to further health complications for your pet including, but not limited to heart disease.

Teeth that need to be extracted are usually either 1) loose or 2) infected. The purpose of dental care for pets is to help them retain as many teeth as possible. However, if your pet has loose or infected teeth they should be extracted for health reasons.

  1. Loose Teeth: Teeth that are loose have pockets between the tooth and the gum that holds food particles. Bacteria will grow in the decomposing food. Everytime the animal chews, bacteria is showered into the bloodstream. This creates increased risk of heart and lung disease and puts a continual strain on the immune system.
  2. Infected Teeth: These teeth have abscesses at the root of the tooth. As this abscess enlarges it erodes the surrounding bone of the jaw causing the adjacent jawbone and adjacent teeth to also become weakened and infected.

If, in the doctor’s professional judgment, these teeth should be removed do you give your consent?

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