Patient Forms

What type of surgery is your pet scheduled for today?

Have you given your pet any medications today?

Has your pet eaten or had water this morning?

Is your pet having any additional issues the Doctor needs to know about?

Is your pet allergic to any medications that you are aware of?

Microchipping with Home Again for $48

*We recommend and encourage Pre-Operative bloodwork to ensure, to the best of our ability, that your Loved One has a safe and effective procedure and recovery.

Would you prefer pre-operative bloodwork with this procedure today?

In the event that emergency treatment is required and I cannot be reached, I authorize the doctors and staff at Helena Veterinary Clinic to perform medical and surgical treatment as is necessary to preserve the life of the patient until I can be contacted for further authorization. I understand that no guarantee of successful treatment has been made. I accept financial responsibility for the treatment of the above named patient and understand that payment is due in full upon release of the animal from the hospital or when services are otherwise terminated. I realize that in many cases it is impossible to determine in advance the extent of medical or surgical treatment required for an animal. In such cases, the hospital staff will attempt to estimate depending upon the extent of treatment required. I understand that my pet is required to be up to date on vaccines, including but not limited to; Rabies, Bordetella, DAPP (canine), FVRCP (feline), and that Helena Veterinary Clinic will vaccinate your pet as needed to comply with this requirement.

*Date

(A Bath n Tidy will include: Bath, Nail Trim, External Expression of Anal Glands, Potty Path, Face and paws trimmed.)

OR, you may choose your coat length:

Additional Notes:

Clinic Policy requires all pets to be current on:

• Rabbies

• FVRCP

• Feline Bordatella

Receptionist cannot guarantee pick-up times. Thank you for your letting us take care of your pet!

*Permission to Sedate for Grooming

*Has your pet eaten today?

How often does your pet eat?

Would you like kennel food for your pet? If not, what brand/type of food are you bringing for your pet's stay?

Are there any special instructions that we should know about for your pet?

Helena Veterinary Clinic Boarding Liability Waiver Any references below to the word “I” also implies all others associated with me, included but not limited to mt spouse, heirs, assignees, and family members.

This section applies to anyone who brings their pet on the Helena Veterinary Clinic premises for any reason.:

I have disclosed to Helena Veterinary Clinic all known risks, dangers and medical conditions associated with my pets.

I understand that I am solely liable for medical care expenses and damages that result from injuries caused by my pet.

I understand that Helena Veterinary Clinic may refuse service to my pet for any reason it deems necessary, including but not limited to overly aggressive behavior, overly excessive barking and illness.

I agree that there are inherent risks in sending my pet to any boarding facility, such as illness, injury, and I accept these risks because they are outweighed by the benefits. Helena Veterinary Clinic will not be liable for illness or injury that may occur to my pet.

I authorize Helena Veterinary Clinic to take actions they deem necessary to ensure the health, wellbeing and safety of my pet and to take reasonable action to resolve any medical problems that may arise while my pet is in their care. I agree to assume full financial responsibility for any and all expenses incurred as a result of their actions. I understand that Helena Veterinary Clinic’s staff is expected to make a reasonable attempt to contact me before incurring such expenses. However, that there is always the possibility of emergency situations where it may not be feasible for them to contact me before the expense is incurred.

I waive all claims or actions against Helena Veterinary Clinic relating to the care, control, health, and safety of my pet while in their care.

Certify that:

• I am the legal owner of the dog/cat I am sending to board with Helena Vet Clinic.

• That, to mt knowledge, my pet has not been exposed to kennel cough, distemper, rabies, or parvovirus within the past 30 days.

• Owner acknowledges that all pets must be up to date in vaccines.