Surgery Check In-

SURGERY CHECK-IN SHEET

Park Plaza Animal Clinic

Procedure requested: _________________________________________     Date: __________

 

PHONE NUMBER WHERE YOU CAN BE REACHED TODAY:  ____________________________________

                                                                                                                                                                                   

Client Name:     ________________________  Patient Name: ________________

 

 

If my animal has fleas, I understand that it will be treated at a cost of $10.30. ________(INITIAL)


                                                                                                                                                               

Routine items:

Has my animal eaten this morning? (Even if it was a small amount)   YES_____NO______

 

Would you like an E-Collar for your pet after surgery?  ($13-$26)   YES_______NO_____

(I understand that the Doctor may require an E-Collar as needed for protection of the surgery site.)

 

Has your pet ever had seizures? YES_______NO_____

 

Would you like to update your pet’s vaccines up to date during the surgery?  YES_____NO_____

 

Please complete the blood work you recommend prior to putting my pet under anesthesia and contact me at the number above if any abnormalities are found ($59 or $119 depending on the age of the animal)   YES_____NO_____

 

Please do a heartworm test with the surgery at a discount ($19 vs $30)  YES______NO_____

 

Please give my pet medication for pain management after the surgery ($30 to $70 depending on size of animal).  YES_____NO_____

 

I would like to have the “Home Again” microchip installed during the surgery ($49)  YES_____NO_____

 

Please do a toe nail trim on my pet while under anesthesia at a discount for only $6.90 (regular price $13 to $22 depending on the type of animal)   YES_____NO_____

 

Please ADD a dental cleaning (in addition to today’s non-dental surgery) for additional cost. Please have the doctor examine my pets teeth and call me with an estimate.   YES_____NO_____

 

Please do anal gland expression under anesthesia for ½ price:  Regular - $27, Today - $14   YES_____NO_____

 

If  we discover a growth or tumor that needs to be removed, I want the doctor to remove it at additional cost.  Please have the doctor call me with an estimate.   YES_____NO_____

 

If there are loose teeth discovered or retained baby teeth interfering with his adult teeth, I want the doctor to remove them while my pet is still under anesthesia (~$15 each)   YES_____NO_____

 

If his ears are dirty and clogged, I want them cleaned and flushed while under anesthesia for only $15 per ear.    YES_____NO_____

 

*(If you have declined bloodwork on an older pet) I have declined pre-anesthetic bloodwork for my pet over 8 years old and understand the risks (see page 2): 

 

_______________________________

Signature of owner

Authorized signature: ___________________________________________________    

 

Date: ____________

 

 

 

 

Free Exam for New Clients! (with a minimum $25 purchase, Can not be combined with any other offer.)

Sign-up using the form or call us at (817) 277-1195 to take advantage of this exclusive offer.

Office Hours

Our Regular Schedule

Monday:

7:30 am

5:30 pm

Tuesday:

7:30 am

5:30 pm

Wednesday:

7:30 am

5:30 pm

Thursday:

7:30 am

5:30 pm

Friday:

7:30 am

5:30 pm

Saturday:

8:00 am

12:00 pm

Sunday:

Closed

Closed

Location

Find us on the map

Testimonial

Read What Our Clients Say

  • "We love this place. Staff is very friendly and prices are reasonable, the Dr. Is very knowledgeable about bulldogs and spends a lot of time with the owners explaining everything. We live 45 mins away but make the drive just because we know we are getting the best! Would recommend to anyone!"
    Daniel P. Arlington, TX

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