At Westwood Veterinary Hospital, we offer patient forms online so you can complete them in the convenience of your own home or office.Client Name:*Today's reachable number:*Patient Name:*SpeciesBreedColorSex (include whether spayed/neutered):Age:Birthday (if known):Scheduled Procedure:We have the option to use a laser to make incisions for an additional cost. There is less risk of infection and less bleeding when we use this method. Would you like your pet to have incisions made by laser? Yes No Would you like your pet’s vaccinations updated today? Please mark any you'd like them to receive. Canine: Rabies DHLPP Bordetella vaccine Rattlesnake Feline Rabies FVRCP Feline Leukemia Additional services that can be performed along with my pet’s surgery: Nail Trim Anal Gland Expression Heartworm Test Fecal Test Ear Flush Dr. Aldridge recommends the following test(s) before any anesthesia procedure which may reveal pre-existing conditions that might show a reason not to proceed. The pre-operative blood profile is required on patients over 6 years of age. The ECG test is required on all patients who have been diagnosed with a heart murmur. I would like to have the pre-operative blood test ($87.50) I would like to have the pre-operative ECG test ($97.50) I understand that during the procedure, unforeseen conditions may be revealed that necessitate an expansion or variance in the procedure(s) authorized above. I expect Westwood Veterinary Hospital to use reasonable care and judgment in performing the procedure(s). The nature of the procedure(s) and the risks involved have been explained to me and I realize results cannot be guaranteed. I am also aware that unforeseen events resulting from the procedure(s) will not relieve me from any obligation to all reasonable costs incurred regarding my pet.Promissory Note: I understand and agree that I am financially responsible for the payment for all services received and will be charged the interest of 1.5% of any balance over 30 days. If legal action is required to collect any fees due, I will be required to pay actual court cost and attorney fees.Signature:*Date* MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged.
