To help us serve you and others better at the time of admission, when completed and signed, please fax this form to us at (952) 472-6367 before surgery day or bring with you on the day of surgery

Westonka Animal Hospital & Laser Surgery Center "Where Smart Pets Bring Their People"

Pet's Name_________________________     Date___________________

I hereby authorize the staff of Westonka Animal Hospital to perform the following indicated procedure(s):

   Tumor(s)Removal     Anal Sac Removal     Orthopedic Procedure     Wound Repair

Other _____________________________________________________

For Tumor, Growth, Cyst, Wart Removal Patients:
Describe or mark the diagrams below where the growth(s) or tumor(s) is or are located on your pet.
Only those marked on this consent form or directly marked on the pet will be removed.
Lesions can be directly marked on pets (if you choose to do this) by you either shaving the area or by you indicating with a permanent marker (remember, the hair in the area will be shaved).

It is in you and your pet's best interests to have your pet anesthetized the fewest number of times, so please help us out by clearly indicating which areas you want surgically removed.
All Tumors, Growths, Cysts, or Warts To Be Removed Must Be Marked Either On This Consent Form or Directly Marked On The Pet. If they are not marked (either on form or on the pet), then they will not be removed.
Verbal instructions to team members at the time of hospital admission may be easily misunderstood and are unacceptable.

Your Pet's Are Counting On You To Learn About Laser Surgery

Rather than a scalpel blade, a laser uses a highly focused beam of light about the size of this period, à^.ßto vaporize cells and nerve endings.

Quote given by veterinarian for additional laser cost:__________________________ (to be filled in at clinic by staff member)

Were you made aware when you made your pet’s surgery appointment that postoperative pain medication was available?
YES    NO   Not Applicable (I didn’t make the appointment)
We have post-surgical Comfort and Pain Care packages available. This package is sent home with you at the time of your pet's discharge, so that you can help to reduce pain and complications at home.
  [     ] YES, I would like to receive a post-surgical Comfort and Pain Care package for my pet. (your investment in comfort is $21.99)
  [     ] NO, I would not like a post-surgical Comfort and Pain Care package for my pet.

  Pet intestinal parasties are a potential health risk to their owners. For more informatin about intestinal parasites and their threat to humans, visit the Centers for Disease Control information at http://www.cdc.gov/ncidod/diseases/roundwrm/roundwrm.htm
Often times our clients have a difficult time getting their pet’s fresh stool to the hospital for an Intestinal Parasite Examination. Intestinal parasites, such as roundworms and hookworms are infectious to people and can cause blindness in children. This test should be done yearly in cats that go outdoors and once every two years for indoor cats. If your cat defecates while at the clinic, would you like for us to collect it and test for parasites?
[    ] Yes, please check my pet's stool. (pet & human health investment is $21.12)
[    ] No, I would not like my pet's stool checked for intestinal parasites at this time.

*I have read and agree to the above statements:

Signed:______________________________