Non-Surgical Form

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Use this form to share your pet’s information, current symptoms, treatment preferences, and CPR wishes so our team can provide non-surgical care safely.

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Your Name(Required)

Patient Information

Symptoms
Please check all symptoms that apply to your pet upon admittance to the hospital today
If not, please skip.
If not, please skip.
I have received a written Treatment Plan of the costs involved. IT IS ONLY AN ESTIMATE.
If I have not already received a Treatment Plan for my pet:
Has your pet ever had any reactions to anesthesia?(Required)
If cardiac and/or respiratory arrest occurs (that is, if a pet stops breathing and/or his/her heart stops beating) then cardiopulmonary resuscitation (CPR) will be performed to revive the pet upon your request.(Required)
I have the authority and I release my pet to the care of Groves Veterinary Clinic. I realize that results cannot be guaranteed and I assume all risks of treatment and failure to follow post operative care recommendations including cage rest and the use of an e-collar. Without an e-collar, your pet is capable of scratching, biting and traumatizing the treatment site impeding recovery and possibly leading to secondary infection and the need for additional treatment at an additional cost to you. An e-collar must be worn until full recovery is achieved.
Owner Signature(Required)
SMS Consent
Email Consent