603-642-9700 staff@pkamc.com

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Surgery/Treatment Consent

Does your pet have a surgery appointment? You can fill out your surgery/treatment consent form securely online by filling in the form below.

pkamc - surgery consent form

Surgery/Treatment Consent Form

Our greatest concern is the well being of your pet. We will perform a physical examination before administering anesthesia. However, disorders of the liver, kidneys or blood, are not detected unless blood testing is done. Abnormalities of any of these may increase anesthetic risk. For these reasons we require limited pre-anesthetic blood screens for pets less than 2yrs. old and more extensive bloodwork for pets over 2 years old. The cost is $135.00 and 165.00.

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. If this is an emergency, or if your pet needs urgent care, please call us at 603-642-9700 for a faster response.

All questions with an asterisk after the question require an answer for this form to be submitted properly.

Phone number to contact you at today *

Date / Time

Owner's Name *

First

Last

Email *

Pet's Name *

Procedure Being Performed *

If my pet is pregnant I still want her spayed? *

Yes
No
Call me before proceeding

Extract any retained baby teeth? *

Yes
No
Call me before proceeding

Perform a Feline Leukemia/FIV/Heartworm Test? *

Yes
No

Perform a Canine Heartworm/Lyme/Anaplasma/E.Canis test? *

Yes
No

Perform a fecal parasite exam? *

Yes
No

Perform a microchip implant? *

Yes
No

Perform necessary vaccination? *

Yes
No

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Request an Appointment

Is your pet due for a checkup? Have a concern? We pledge to provide compassionate and professional care to pets in Kingston, NH and beyond. If this is a pet emergency, please call (603) 642-9700 or visit Port City Veterinary Referral Hospital - IVG (603-433-0056).

Address

48 Route 125, Kingston, NH 03848

Phone

(603) 642-9700

h

Fax

(603)-642-9703

Email

staff@pkamc.com

Hours

Mon-Fri: 9 AM - 6 PM
Sat - Sun: Closed

Have a Question?

Use the form below, and we'll get back to you as quickly as possible.

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