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Lake Country Veterinary Care Surgical Packet

Name: Lake Country Veterinary Care
Address: 2527 Cherry Valley Turnpike, Marcellus, NY, 13108, United States
Telephone: 315-673-4858
Price range: $

Thank you for scheduling a surgery at our clinic. Please fill out this form prior to bringing your patient for their surgical appointment. If you have any questions about the procedure your pet is having performed, the cost involved, or if you need assistance filling out this form, please do not hesitate to call or text our office at 315-673-4858.

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Surgical Packet

Please fill out this form to the best of your ability prior to your appointment. If you have any questions or concerns prior to your appointment please contact our office at 315-673-4858 or via email at [email protected].

To prevent the spread of infectious diseases and parasites, we require all surgical patients to be current on vaccinations and free from internal and external parasites. If your pet received vaccinations somewhere other than our facility you must provide proof of vaccination prior to your surgical appointment.

Pre-Op Questionnaire
Surgery Consent Form
Options Relating to Anesthesia

Date of Surgical Appointment *

Client Name *

First

Last

Pet Name *

Phone number to call after surgery *

Additional phone number

Has your pet eaten in the past 8 hours? *

Has your pet had any illnesses (i.e. coughing, sneezing, vomiting, diarrhea) in the past 7 days? *

If yes, please list:

Does your pet have any history of seizures, liver or kidney disease, or heart condition? *

If yes, please list:

To your knowledge, has your pet had any previous anesthetic complication? *

If yes, please list:

Is your pet currently taking any medications? *

If yes, please list all medications, the dose you administer, and when the last dose was given.

Is your pet allergic to any medications/drugs? *

If yes, please list all medications, the dose you administer, and when the last dose was given. (copy)

Has your pet recently shown any signs of exercise intolerance? *

Has your pet's eating and drinking habits changed in the last 30 days? *

Has your pet experienced any trauma in the past 7 days? *

Has your pet experienced any major weight loss or gain recently? *

Is your dog current on heartworm preventative? *

Yes
No
Not Applicable (N/A)

If given the option, would you prefer medication in a liquid or tablet form? *

Yes
No
No preference

Signature *

Today's Date *

Name *

First

Last

Pet's Name *

The surgical procedure my pet will be having performed today is *

Spay/neuter
Mass removal
Comprehensive oral health assessment and treatment (COHAT)
Dental extractions
Other

Please Describe *

Please sign your name and the date you are filling out this form after each of the following statements acknowledging that you have read and understood them.

I have been advised of the nature of the procedure(s) stated above and I have also been made aware of the possible complications of this procedure. *

Date *

I give permission to Lake Country Veterinary Care to perform the surgical procedure stated above. Lake Country Vet Care will take all necessary precautions to ensure the safety of my pet; however, I acknowledge that there is an inherent risk with any medical/surgical procedure and subsequent anesthesia/drugs required to complete them. *

Date *

Should an unforeseen emergency arise while my pet is in the care of Lake Country Veterinary Care I authorize all necessary procedures or treatments and will assume all financial responsibility. *

Date *

Microchip Implantation

A microchip is a device implanted in the subcutaneous space usually between a pet's shoulder blades. This device has a unique tracking number that will be registered with the PetLink database. This number allows for fast identification and hopefully the safe return of your pet in the unforeseen instance that your pet becomes lost.

While your pet is under general anesthesia you have the option to have a microchip implanted. While anesthesia is not required for microchip implantation, it does provide an opportunity for a less painful and stress-free placement of the microchip. The cost of this elective service is $52.12. I would like Lake Country Veterinary Care to implant a microchip in my pet. *

Therapeutic Laser Treatment

Laser therapy is a drug-free, non-invasive treatment performed immediately following a surgical procedure. Laser therapy has been proven to reduce inflammation of the surgical site and promote faster healing.

I would like Lake Country Veterinary Care to perform therapeutic laser for my pet following their surgical procedure. I accept the cost of this treatment: $15.30. *

Please sign your name and enter the date after reading the following statement: I understand that I am financially responsible for all charges incurred from medical treatment at this facility. I agree to pay any and all charges at the time services are rendered. I understand that an estimate can be made available upon my request if one has not already been presented to me for the requested procedure/treatment described in this document. *

Date *

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We proudly bring lifelong wellness to the pets of Skaneateles, Marcellus, Tully, Lafayette, and beyond. Easily request an appointment for your pet using our online system!

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Address

2527 Cherry Valley Turnpike, Marcellus, NY 13108

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Contact

Phone: 315-673-4858

Email: [email protected]

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Hours

Mon – Fri: 8 AM – 6 PM
Sat & Sun: Closed

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Have a question? Complete our online form, and a member of our team will be in touch with you shortly. If you’re in need of immediate assistance, please call or text us at 315-673-4858.

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