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Species*

Breed*

Age*

Sex*

Current Weight*

Unit Date*

My pet is being admitted today for procedure(s) and/or treatments to be performed

Other

2. All pets entering the hospital must be free of internal and external parasites (fleas, ticks, roundworms, tapeworms, etc.) or they will be treated at owner’s expense.

4. I have received a verbal or written estimate on today’s procedure(s) for my pet(s) visit in the hospital.

7. Kingsport Veterinary Hospital is not a 24-hour Hospital. We do NOT have a staff member at the hospital overnight. I understand that continuous presence of personnel is not provided during night time hours or weekends. I have the option of taking my pet to The Airport Emergency Hospital or other 24-hour Hospital if such care is deemed necessary. I understand and agree that if I do not come for my pet by 5 pm and he/she is not stable enough to stay at the hospital unattended overnight, he/she will be admitted to the Emergency Hospital and treated at my expense.

8. Pre-surgical bloodwork is strongly recommended by the doctor and may be required depending on your pet's age and/or health status. Pre-surgical bloodwork may be required for all senior pets (over 6 years old).

What is CPR?

Cardiopulmonary resuscitation (CPR) is a procedure to support and maintain breathing and circulation for a patient who has stopped breathing (respiratory arrest) and/or whose heart has stopped (cardiac arrest).

Level 1: IV catheter, endotracheal intubation (assisted breathing), oxygen therapy, rescue drugs, chest compression In the event that an emergency should arise, I give permission for the doctors/staff to perform/use lifesaving measures such as CPR: (Additional cost: begins from $300.00 to 1000.00)

Financial Policy

We Do Not Accept Payment Arrangements

Other*

Full payment is required at the time of pick up

FOR ESTIMATES... Due to the nature of medicine, your total may be up to 15% higher than the high amount of your estimate.*** Every effort will be made to stay within the range of the estimate.

Initials*

Is your pet currently taking any medications? If yes, what medications?*

Has your pet had any complications with any medications, or anesthesia?*

I have read, understand and agree to all of the above. I also understand that there is always risk associated with general anesthesia or sedation and I have had an opportunity to discuss these risks with a doctor or staff member.

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Today's Date*

Kingsport Veterinary Hospital

Hospital Admittance Surgery Form

What is CPR?

Financial Policy

Full payment is required at the time of pick up

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