Notice: We will be closing early Friday December 8th at 4:30PM. Thank you.

We will be closed Monday, December 25th for Christmas!
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Surgery Form

Save time during your next appointment. Complete your required surgery form online from any device at any time before your visit.

Surgery Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet before your visit.

PDF Form

Just fill out and send to our team at northgateanimal.xray@gmail.com.

NORTHGATE ANIMAL HOSPITAL SURGERY ADMITTING FORM

OWNERS CONSENT FOR ANESTHESIA AND SURGERY

Drop Off And Pick Up Times

  • Drop off is between 7:30AM-8:00AM. Please note the clinic and doors open at 7:30AM.
  • Bring your pet with this completed form.
  • Please bring all your pet's medication and any records, radiographs, etc.
  • All pain medication for your pet will be prescribed if needed, and will be an additional fee to the surgical cost on your final bill.
  • Your pet will need to be picked up by 6:00 PM unless otherwise notified or your pet is hospitalized overnight.

BLOODWORK

*We REQUIRE that pets over 9 years of age and over have pre-anesthetic blood work blood tests done prior to any anesthetic surgery. This test is a Chemistry Panel and PCV blood test. This pet will also be placed on IV fluids during the surgical procedure per the hospital's surgical protocols. The total cost of these treatments are $186.20.

LASER SURGERY

*ALL DECLAW SURGERIES ARE REQUIRED TO BE DONE WITH THE SURGICAL LASER, NO EXCEPTIONS CAN BE MADE WITH DECLAWING.

CURRENT MEDS

ALLERGIES

BIOPSY

VACCINATIONS

FLEAS

MICROCHIPPING

ADDITIONAL TREATMENTS

*YOU MAY BE REQUIRED TO LEAVE A DEPOSIT BY TELEPHONE.
YESNO
Is your pet eating and drinking normally?
YES
NO
Is your pet weak or lethargic?
YES
NO
If your pet vomiting?
YES
NO
Does your pet have diarrhea?
YES
NO
Does your pet strain when urinating?
YES
NO
Does your pet have blood present in its urine?
YES
NO
Is your pet coughing?
YES
NO
Is your pet sneezing?
YES
NO
Is your pet gagging?
YES
NO
Has your pet been exposed to any other pets recently?
YES
NO
Has your pet had surgery recently?
YES
NO
Does your pet chew/eat begging, toys, etc?
YES
NO
Is your pet limping?
YES
NO

DOGS

CATS

CPR CODE Consent Agreement

***Animals that have been successfully resuscitated are extremely critical and unstable. The likelihood of re-arrest is high and usually occurs within 4 hours of the initial arrest. If resuscitation is successful, there is only about a 20% chance that a pet will stay alive for the first 4 hours after resuscitation. The percentage of long term survival is even lower, and may be as low as 1%, depending upon what caused the arrest. Brain damage is common due to temporary lack of oxygen to the brain, which can result in blindness and/or impaired mental function, leaving a pet with physical and/or mental disabilities. This impairment may last for days, weeks, or years.

l am the owner or agent of the owner of the above named pet and hereby authorize the performance of treatment for this pet. I understand that unforeseen conditions may necessitate an extension of the treatment or a different treatment may be recommended and therefore authorize such treatments as necessary in the professional judgment of the veterinarian. I authorize the use of appropriate aesthetics and mediations in the treatment of this pet. I have and will be advised of the nature of the treatment and I understand that while every effort will be made to provide the best care for my pet, results cannot always be guaranteed. I understand that all fees must be paid in full at the time of release unless other arrangements have been made in advance with the veterinarian, medical director or with the practice manager of Northgate Animal Hospital. I have read the above information: I understand and agree to the conditions and policies of Northgate Animal Hospital.