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Today:
7:30 am - 6:00 pm
Open Hours
(850) 994-1597
Phone Number
4541 Chumuckla Highway
Pace, FL, 32571
Request an Appointment
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today:2023-03-21
Pre-Surgical Check-in Form
Please enable JavaScript in your browser to complete this form.
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Step
1
of 2
Owner Name
*
First
Last
Phone Number
*
Please enter a valid phone number.
Additional Phone Number
Please enter a valid phone number.
Email
*
example@example.com
Pet's Name
*
Species
*
Dog
Cat
Male/Female
*
Please Select
Spayed Female
Neutered Male
Intact Female
Intact Male
Age
*
Weight (LBS)
*
What Anesthetic procedure are we doing today?
*
Do you have a preference in which Veterinarian does the procedure?
*
Please Select
Dr. Mongue
Dr. Walker
Dr. Holderman
No Preference
Has your pet had the following?: vomiting, diarrhea, extreme lethargy?
*
Have you ever witnessed your pet have a seizure? If so, when? and how long?
*
*FEMALE ONLY* Is your pet in heat or possibly pregnant?
*
Has your pet been fasting since midnight?
*
Yes
No
Does your pet have a growth you would like removed? Please explain in detail the location and size.
*
It is recommended that we send out any growth removals to be tested. Would you like for us to send it out? $157.00
*
Yes
No
These services are not required but are highly recommended when doing any anesthetic procedure.
*
Pre-surgical Bloodwork $66.40 (This is recommended to be able to see your pets bloodwork levels and tell us if we need to adjust pre-medication dosages)
IV fluid therapy $69.18 (This is recommended to help keep your pet warm and help flush out the anesthetic medication during anesthesia)
Propofol $56.00 (This is recommended to help keep your pet asleep during anesthesia and make the transition from awake to asleep smoother)
E-Collar $10.07-$18.36 (This is recommended to be taken home after any cutting procedure, this will help prevent your pet from licking/chewing incision site)
N/A
Would you like any extra services?
*
Nail Trim **Free of charge with anesthetic procedure**
Anal Gland Expression $25.00
Ear Cleaning $16.12
Microchip $65.00
N/A
Other
If other, please list below:
Other:
What medications is your pet currently taking?
*
Next
Would you like any refills on medication? If so, which ones?
*
EX: Heartworm, Flea, Allergy
Please select a time between 4:00pm and 5:30pm that you would like to pick up your pet.
*
Please Sign here to authorize the above anesthetic procedure.
*
Clear Signature
Submit
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