Owner's Name(Required)
Pet's Name(Required)
I certify that I am the owner, or authorized agent for the owner. I hereby consent to and authorize the doctors and team of Johnston Animal Hospital to admit this pet and perform the procedure indicated on this form. I understand I will be given a health care plan to review at the time of my pet's admission to Johnston Animal Hospital. I acknowledge that I am responsible for payment in full for the procedures and treatments at patient discharge.(Required)
I understand that my pet will need to be up to date with all JAH's required vaccines 2 weeks prior to staying with JAH for their procedure.(Required)
Pre-Anesthetic Blood Work(Required)
Pre-anesthetic blood work is used by the doctor to evaluate organ function and metabolic function before anesthesia. Understanding blood work values helps the doctor to determine the safest anesthetic choice(s) for your pet. The cost of the blood work will be included in your pet's Health Care Plan.
Please select the surgery your pet is scheduled to have:(Required)
Laser Surgery(Required)
Dr. Ward recommends CO2 surgical laser technology for spay, neuter, and other procedures. The benefits of laser surgery include less pain, less bleeding, reduced swelling, lower chance of infection, shorter hospital stays, and quicker recovery. Please indicate if you would like the benefits of laser surgery for your pet.
Microchip Installation(Required)
Johnston Animal Hospital uses tiny microchips to provide your pet with permanent identification. If your pet is lost or stolen, microchips can be easily scanned and read throughout the US in order to help return your pet home. It is painless for your pet to receive the tiny microchip while your pet is under anesthesia. Our hospital will complete the registration process for you so that you do not have to worry about it. Please select if you would like us to microchip your pet to help assure their safe return.
Life-Saving Emergency Care(Required)
I understand that all procedures will be performed to the best of the abilities of the team at Johnston Animal Hospital. However, I accept that veterinary medicine is not an exact science and that no guarantee or warranty has been made regarding the results. Select ONE option below for your pet so we can be prepared in an event that life-saving emergency care is needed:
Fasting:(Required)
To reduce anesthesia complications, it is important that your pet has an empty stomach prior to anesthesia. I agree to fast my pet from all food for a minimum of 12 hours prior to surgery. I understand that if my pet eats in the 12 hours prior to surgery, then the surgery may need to be rescheduled for my pet's safety.
Johnston Animal Hospital is not open 24-hours; therefore, if my animal is hospitalized or boarding overnight there will not be 24-hour supervision. If I desire 24-hour supervision of my animal, then I understand that I can request to transfer my animal to a 24-hour veterinary emergency or specialty hospital. I acknowledge that the responsibility for transporting my pet to the 24-hour emergency/specialty facility and the additional fees incurred for care at that facility would be my own.(Required)
Are you currently giving your pet any medication(s) other than heartworm prevention and/or flea and tick prevention?(Required)
Other than what our hospital records show, does your pet have any history of the following:(Required)
Please type "none" if you do not intend to leave an item.
I approve for my pet to have bedding while staying at Johnston Animal Hospital and I verify my pet has not had problems in the past eating or chewing on bedding.(Required)
Addtional Lifestyle Vaccines(Required)
Please check any additional lifestyle vaccines that you would like for your pet to receive while at JAH. Any additional services selected will be included in your health care plan that you will be provided on the day of surgery
Addtional Optional Services(Required)
Please check any additional procedures that you would like us to perform while your pet is under anesthesia. Any additional services selected will be included in your health care plan that you will be provided on the day of surgery.
I understand that Johnston Animal Hospital is not open 24-hours; therefore, if my animal is hospitalized or boarding overnight there will not be 24-hour supervision. If I desire 24-hour supervision of my animal, then I understand that I can request to transfer my animal to a 24-hour veterinary emergency or specialty hospital. I acknowledge that the responsibility for transporting my pet to the 24-hour emergency/specialty facility and the additional fees incurred for care at that facility would be my own.(Required)
I understand that if my pet has signs of fleas or ticks, the team at Johnston Animal Hospital will administer a dose of Bravecto to my pet. I understand that I will be charged an additional fee for this treatment.(Required)
I understand that if pet has soiled themselves, the team at Johnston Animal Hospital will give a necessary freshening bath. I understand that I will be charged an additional fee for this treatment.(Required)
I understand I will need to bring my pet in for surgery between 7:00am - 7:30am on the day of their surgery.(Required)
I hereby certify that, to the best of my knowledge, the information provided is true and accurate.(Required)
I certify that I am the owner, or authorized agent for the owner. I hereby consent to and authorize the doctors and team of Johnston Animal Hospital to admit this pet and perform the procedure indicated on this form. I understand I will be given a health care plan to review at the time of my pet's admission to Johnston Animal Hospital. I acknowledge that I am responsible for payment in full for the procedures and treatments at patient discharge.