Avian Forms | Avian & Exotic Philly Medical Surgical Clinic

Husbandry Form

Avian Husbandry Form

Please Select One *

I elect CPR

My pet is a DNR

Name *

Name

First

Last

Date *

Email *

Phone *

Address *

Address

City

State/Province

Zip/Postal

We regularly post photos of our patients to our social media, both for education and for fun! Do you give us permission to post photos of your pet? *

YES I give permission to post photos of my pet(s)

NO please do not post my pet(s) on social media

How did you hear about our clinic?

Current client

Social Media

Website

Veterinary Emergency Group (VEG)

OtherOther

Name of client

Please Specify

If you are human, leave this field blank.

Surgical Consent & Admission Form

Client Consent Form

Please Select One *

I elect CPR

My pet is a DNR

Client Name *

Client Name

First

Last

Date *

Email *

Daytime Phone *

Evening Phone *

Patient Name *

Anesthetic and Surgical Procedures to be Performed *

Current Medications *

Has your pet taken any medications today? *

Yes

Please indicate medications administered today

Medication

Amount Administered

Time

Add another medication Remove a medication

Is your pet due for any medications while in our care? *

Yes

Meds Due Today

Medication

Time

Add another medication Remove a medication

Do you need medications refilled today? *

Yes

Medication Refills

Is your pet due for blood work or other diagnostics? *

Yes

Diagnostics Due

Are there any other services requested today while your pet is under our care? *

Yes

Requests

Please read carefully and sign.

I, the undersigned owner or agent of the pet identified, authorize the veterinarian(s) and staff at Avian & Exotic Medical Surgical Center to perform the above procedure(s). I understand that some risks always exist with anesthesia and surgery and that I'm encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure(s) is/are initiated.

My signature on this form indicates that any questions I have regarding the following issues have been answered to my satisfaction:

The reasonable medical and/or surgical treatment options for my pet
Sufficient details of the procedures to understand what will be performed
Anesthesia risks are understood
The most common and most serious complications
The length and type of follow-up care required
The estimate of the fees for all services provided
Expectations on time for recovery
Your pet may require feathers or hair removed to enable the surgeon to perform today's procedure

Please check one *

I elect CPR

My pet is a DNR

We may require a blood profile before anesthesia and surgery to ensure that your pet is in a low-risk category. The latest technology lets us run safe, accurate blood chemistries minutes before anesthetic induction. These tests are similar to those your own physician would run were you to undergo anesthesia. In addition, the results of these tests will serve as reference values for future use should your pet become ill.

Please indicate if you approve of these diagnostics *

I approve

I do not approve

Please note that blood work is required for Spay and Neuter procedures.

While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved. I agree to assume financial responsibility and provide payment via cash, credit card, or check. I have read fully and understand the terms and conditions set forth above.

Photo of Pet Upload

Maximum file size: 52.43MB

Signature of owner or authorized agent *

Clear

Date *

If you are human, leave this field blank.

Behavior Assessment Form

Form Coming Soon