Forms

Veterinary Care Forms

Medical Form — Stethoscope with Medical Form in Citrus Heights, CA
Thank you for giving us the opportunity to care for your pet. Please download the form you need, complete the information and bring it to the hospital at the time of your appointment.

Forms and Requirements

New clients

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Animal Information

The undersigned agrees to let Sylvan Corners Pet Hospital examine, treat, and/or care for this animal and assumes responsibility of all charges incurred in the care of this animal. Payment is required at the time of services rendered. We do not accept checks or American Express cards. If you are active duty or retired military, please let us know.

How would you prefer to receive reminders for annual services such as vaccinations, examinations, etc. from us:

How did you learn about our hospital:

Surgical consent

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Sylvan Corners Pet Hospital maintains personnel and facilities to aid your pet's veterinarian in the performance of various surgical and medical procedures. Most surgeries and medical procedures are successful; however, on rare occasions some procedures may involve unsuccessful results, need further work-up, or have complications, injury or even death from both known and unforeseen causes. There is no warranty or guarantee as to the results or cure. If the procedure which your pet is scheduled requires the use of sedative medications or general anesthesia, you acknowledge this has been explained to you and you consent to their use.

Your pet is undergoing a surgical procedure today and will be staying in our hospital for several hours. For the safety of your pet as well as the safety of others, we require all dogs and cats to have current vaccines. We also require a current heartworm test for dogs over 6 months of age.

Anesthetic procedures have inherent risks. In an effort to minimize these risks we recommend pre-surgical blood work for all pets. This is a requirement for pets 8 years of age and older. The cost is $126.00. (Please initial one)

Yes, I want pre-surgical blood work to be performed on my pet.
No, I understand the risks of anesthesia and decline pre-surgical blood work.

Would you like your pet microchipped today? The cost is $54.00, which includes a lifetime registration through HomeAgain. (Please initial one)

Yes, I would like my pet microchipped today
No, I decline a microchip.

For most surgical procedures we strongly recommend pain medication to go home with your pet as well as an e-collar. The prices range depending on the size of your pet. Please initial which one(s) you would like.

Pain medication to go home.
E-collar to go home.

In the event that additional non-emergency  veterinary services become necessary during your pet’s stay with us, please tell us how you wish to proceed (please initial one):

Try to contact me first; if I cannot be reached, proceed with any additional procedures deemed necessary by veterinarian. (Charges above the estimated amount will be due upon discharge)
Do nothing over estimated amount until I can be reached for approval.

In the event that emergency  veterinary services become necessary, including but not limited to: CPR, cardiac compression, mechanical respiration, emergency injectable drugs, or other heroic interventions, please tell us how you wish to proceed (please initial one):

Proceed with any and all emergency services. (Charges above the estimated amount will be due upon discharge)
Do not proceed with any emergency services.

Sylvan Corners Pet Hospital maintains personnel and facilities to aid your pet's veterinarian in the performance of various surgical and medical procedures. Most surgeries and medical procedures are successful; however, on rare occasions some procedures may involve unsuccessful results, need further work-up, or have complications, injury or even death from both known and unforeseen causes. There is no warranty or guarantee as to the results or cure. If the procedure which your pet is scheduled requires the use of sedative medications or general anesthesia, you acknowledge this has been explained to you and you consent to their use


Your signature below constitutes your acknowledgement that you have read and agreed to the above:

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