About
Services
- Training Classes
- Wellness Plans
Resources
Business Hours
Emergency / After Hours
Contact

Treatment Release

Download the Form

Submit Treatment Release Form Online

"*" indicates required fields

In preparation for surgery, we request that all pets be fasted after 10:00pm on the previous evening; water may be offered. Was your pet fasted as described above?*

Yes

No

Is there any personal or medical information pertaining to your pet that you would like to share with us?*

Yes

No

If you answered yes, please share this information below.

We require that hospitalized pets be up to date on all vaccinations, fecal exams, heartworm testing, and preventive medication. We also check for fleas and treat pets if necessary. May we have permission to provide these services for your pet?*

Yes

No

Post surgical laser therapy is offered to help reduce pain and promote healing. Cost is $16. Would you like us to perform this procedure today?*

Yes

No

Microchips are available to provide a permanent way of identifying your pet if lost or stolen. These microchips are placed under the skin while your pet is anesthetized and the number can be detected with a microchip reader for the rest of your pet’s life. The cost of this service is $45 including the registration fee. Would you like us to perform this procedure today?*

Yes

No

If your pet is a FELINE, we recommend testing for feline leukemia and feline immunodeficiency virus at least once in a lifetime of an indoor cat and annually in those cats that go outdoors. The cost of this service is $47. May we have permission to perform this test today?*

Yes

No

Please list current medications your pet is on, other than heartworm and flea prevention and last dose taken.

I give permission for Kibby Park Animal Hospital to perform the procedure stated below on my pet. The doctors and staff will take precautions to insure the best outcome for my pet. I am aware that the hospital is not staffed overnight. I agree to pay the fees associated with this procedure at the time of my pet’s discharge from the hospital.

Procedure*

Owner's Name*

First Last

Patient's Name*

Digital Signature*

Please type your full name to sign this form.

I Confirm That I Have Read and Agree to This Consent Form*

Agree