Patient Name Procedure to be performed Please read through the following information and initial your selections.Bloodwork - Like you, our greatest concern is the well-being of your pet. Before putting your pet under anesthesia, we will perform a physical examination. However, many conditions including disorders of the liver, kidneys, or blood are not detected without additional testing. Such tests are especially important before any kind of surgery. For these reasons, we highly recommend blood screening before each procedure. Our hospital is equipped to perform these important blood tests prior to your pet's anesthesia. If there is a problem with any of the tests in this screening, other options will be discussed with you if necessary. The blood test for pets under 7 years old is $55.00, for pets over 7 years old the cost is $94.00. YES, I want my pet to have pre-anesthetic blood testing. NO, I do not want my pet to have pre-anesthetic blood testing. Microchip - This is a very good time to implant a permanent identification marker (microchip) in your pet in case he or she is lost or stolen. Animal control hospitals and most veterinary hospitals have scanners to read these microchips in order to reconnect owners to their pets. The additional cost is $45.95 YES, I want my pet microchipped at this time. NO, I do not want a microchip implanted at this time. Hip Dysplasia is a problem in dogs that will weigh more than 40# as an adult. Hip dysplasia is a poor formation of the ball and socket joint. It can be very painful, leading to crippling and a poor quality of life. If detected early, many treatments are available to increase comfort and slow the progress of the disease. As early detection is important, we are offering a 25% discount to do radiographs while your pet is sedated today (regular $96.00, discounted price $72.00). YES, I would like my pet's hips x-rayed today. NO, I do not want my pet's hips x-rayed today. I am the owner or agent of the above described animal and have the authority to execute this consent. I hereby consent and authorize the performance of the above listed procedure(s) or operation(s). I authorize the use of appropriate anesthetics and/or other medications deemed necessary to complete the listed procedure(s). I also understand the nature of the procedure(s) or operation(s) and understand that risk may be involved if sedation or anesthesia is employed. I also realize that results cannot be guaranteed. I accept full financial responsibility for the services rendered on behalf of this patient. I understand that payment is due in full upon release of this patient and that payment may be made by cash, check, MasterCard or Visa. I understand that Kindness Small Animal Hospital does not have a payment plan, extended credit plan or billing policy. I have read and understand this form. Can we text? Yes No SignatureBest Contact NumberClient's Name First Last PhoneThis field is for validation purposes and should be left unchanged.