Surgical Admission Form

Your Pet's Name*
The breed of your pet*
I certify that I own the above described animal, and do hereby consent and authorize Doctors R.C. Riggs, D.L. Heidrich, T.J. Kyle and A.M. Baltzell or their associates to care for my pet. I understand that risks exist with the use of medications, testing procedures, anesthesia, and surgery. I am encouraged to discuss any concerns that I have about the procedures(s) and risks involved and I also understand results cannot be guaranteed.*
- Accept
Payments: I am aware that unforeseen events resulting from the procedure(s) will not relieve me from any obligation to all reasonable costs incurred. Furthermore, all fees due for the care and treatment of my pet will be paid in full the day that my pet is discharged from the hospital. In the event that I fail to pay these fees, I will be liable for the reasonable costs of collection, including court costs and attorneys fees.*
- Accept
Preanesthetic Bloodwork: This is an in-house blood screening to test liver and kidney values. It helps us to determine if your pet is a good candidate for anesthesia. There is an additional cost for this service.*
- YES, I WOULD LIKE pre-anesthetic testing.
- NO, I DO NOT WANT pre-anesthetic testing.
Dental Patients
- Please call for approval
- Please call for anything over estimate (recommended)
- Approval received at drop-off
FIV/Feline Leukemia/Heartworm Testing: This is recommended for all cats that have not yet been tested or any cat that goes outside, has had cat bite wounds, or is acting sick. There is an additional charge for this test.
- Yes
- No
Other Services: We can provide these additional services while your pet is under anesthesia for an additional cost. Please select the services you would like performed today.
- Nail Trim
- Anal Gland Expression
- Microchip Placed
Please confirm that you have received an estimate for your pet's procedure.*
- I have received an estimate
- No
- Not needed
Vaccination: All pets must be current on vaccinations for entry to the Best Friends pet hospital. By submitting this form I agree that my pet is fully vaccinated. If vaccinations were performed by someone other than Best Friends, I will provide records of vaccination.*
I hereby acknowledge that I have read and agree to the above terms and conditions.
If my pet isn't up to date on vaccinations, Best Friends will need to vaccinate my pet for it to be admitted to the hospital. I understand there is an additional charge for this service. Best Friends will gladly provide me with an estimate of the costs if desired.
Contact Information where we can reach you today WHILE YOUR PET IS UNDER ANESTHESIA if necessary:
Primary Contact Name
First Last
Primary Contact Phone
Primary Contact Preference
- Call only
- Text only
Appointment Date
Date Format: MM slash DD slash YYYY

Leave empty if appointment not yet scheduled.

Contact

P:614-889-PETS (7387)
E: bestfriends275@gmail.com

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Address

275 West Olentangy Street
(Powell Road) Powell, OH 43065

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Hours

Mon-Thur: 8 am-6 pm
Friday: 8 am-5 pm
Saturday: 8 am-Noon
Sunday: Closed

Surgical Admission Form

Contact Information where we can reach you today WHILE YOUR PET IS UNDER ANESTHESIA if necessary:

Contact

Address

Hours