Skip to content
Make An Appointment
Home
Our Hospital
Our Doctors
Our Staff
Hospital Tour
Payment Options
Forms
Careers
PetDesk
Services
Wellness Exams
Vaccinations
Spay & Neuter
Dental Care
Orthopedic Surgery
Soft Tissue Surgery
Microchipping
Senior Wellness
View All Services
Boarding
Shop Online
Blog
Contact Us
Home
»
Anesthetic Consent Form
Anesthetic Consent Form
Name
(Required)
First
Last
Email
(Required)
Pet's Name
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
Please enter a valid phone number.
I consent and authorize Bemidji Veterinary Hospital to perform the following procedure(s) on my pet.
I understand that if my pet is not current on its Rabies vaccination, and should my pet be healthy enough to respond to the vaccine, the vaccine will be given and the fee added to the invoice ($40).
Initial here
Bemidji Veterinary Hospital is a flea/mite free environment. If your pet is found to have fleas/mites they will be treated IMMEDIATELY at your expense.
Initial here
Additional services to receive while here (added cost)
DAP(canine) $48 or $69
Rabies(canine/feline) $40 or $58
Kennel Cough (canine) $38
RCPC (feline) $38 or $57
Feline Leukemia $44
Nail trim $37
Anal Glands $47
Microchip $86
Lyme/Lepto (canine) $59
Lyme (canine) $47
Each pet experiences pain in different ways. Studies show that post operative pain medication can substantially improve recovery. This is an option for all procedures.
Yes, I would like pain medication to go home ($20-$50)
No, I would not like additional pain medication to take home ($0)
Cold laser therapy has been proven to reduce pain and inflammation and leads to a more comfortable recovery.
Yes, I would like cold laser therapy to be performed on my pet ($28)
No, I would not like cold laser therapy to be performed on my pet ($0)
Procedures requiring anesthesia are always associated with a certain amount of risk. Like you, we want to minimize that risk as much as possible-this requires a physical exam (included in the cost of surgery) and pre-anesthetic blood work. Bloodwork allows us to detect underlying metabolic problems, such as diabetes, liver or kidney disease, anemia, etc, which may make anesthesia more risky. We advise the following pre-anesthetic blood work/tests be performed, even with elective procedures such as spays, neuters, and dentals:
In House Comprehensive Screen with SDMA (canine/feline) $300
4 way Snap Test for lyme/anaplasmosis/heartworm/ehrlichiosis $90
Fecal test for parasites/giardia (In House) $100
FelV/FIV test (feline) $100
DENTALS ONLY: Does your pet have any orthopedic or heart implants?
No
Yes (if yes, they will require IV antibiotics during their procedure to maintain the integrity of the implants)
I understand that my pet will be considered abandoned if Bemidji Veterinary Hospital has not heard from me within 7 days of the expected date of discharge. Bemidji Veterinary Hospital is authorized to dispose of my pet as they deem best including euthinasia (putting the pet to sleep) and I am financially responsible for all charges accrued. I expect that the veterinary team will use reasonable precautions to assure my pet's safety while in your care, but I further understand that no guarantee of successful treatment has been made. I certify that I understand this, release, and assume full financial responsibility of all charges accrued.
Initial here
Signature
(Required)
Make an Appointment
Find Us
Online Pharmacy
What's Next
1
Call us or schedule an appointment online.
2
Meet with a doctor for an initial exam.
3
Put a plan together for your pet.
Make An Appointment