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Surgical Intake Form
North Phoenix Animal Clinic

Save time at your next appointment! Please complete your required Surgical Intake Form online from any device at any time before your visit.

Surgical Intake Form

Please complete this form completely and accurately so that we can get to know you and your pet(s) before your visit. If this is an emergency or your pet requires immediate attention, please call us at 602-787-4240 for a faster response.

Owner's Information

Animal's Information

When Was The Last Time Your Pet Was Vaccinated

Authorization of services

If your pet is here for an anesthetic procedure, bloodwork is required for all animals over 5 years of age. It is also recommended that bloodwork be performed before any anesthetic procedure, regardless of the animal’s age, to help identify any pre-existing medical conditions and help ensure that your animal is healthy for the procedure.
Please indicate if you would like the following today:
It is strongly recommended that all dogs have an E-collar (cone) after any surgical procedure. This is to prevent licking, especially after spays and neuters. The cost of an E-collar is $15 from our facility. Failure to use an E-collar after surgery may result in complications, for which the owner assumes all responsibility.

Dental Procedures

If your animal is here for a dental procedure today, then please be advised that extractions (removal of teeth) are an extra cost. We will not remove teeth unless it is absolutely necessary. We try and estimate how many extractions an animal will need at the time of the exam, but sometimes we cannot tell which teeth are diseased until your animal is under anesthesia. We have dental radiographs that are used to assist us in deciding the health of your animal's teeth. Please understand that It is not always possible to call owners in the middle of an anesthetic procedure, so by signing below you authorize North Phoenix Animal Clinic to extract all of the teeth that the doctor feels are necessary. We will do our best to give an accurate estimate range of how much the dental procedure will cost, but sometimes there will be additional costs (such as medications to go home) along with extractions. We also recommend supplemental fluids (either IV or subcutaneous) for all dental procedures(this is an option for all surgical procedures). There is an additional charge for this.