dog

Ace of Spays Dog Sign-In Form Copyright 2012

PLEASE NOTE: We will not recieve your form information until you click the submit button below and you see a Thank You Screen.

*Date of Your Appointment (required)

Referred by:

Owner Information

*Mr./Ms.

First Name

*Last Name (required)

*Street Address (required)

*City (required)

State (required)

State

*Zip Code (required)

*Email Address (required)

*Re-Enter Email address (required)

*Phone Number (required)***

Alternate Phone Number

***IMPORTANT: Please provide phone numbers where you can be reached ALL DAY while your pet is with us.

Dog's Information

*Name

*Type of Pet (required)

*Estimated Age (required)

Birthday

We strongly recommend pre-operative bloodwork and IV fluids for pets over 5 years of age.
Call 609-267-6770 to set an appointment at least 3 business days before surgery for bloodwork.
You will find a check box for IV fluids under extra services below.

Date of Last Heat

*How many testicles are visible? (REQUIRED)

Please cancel your appointment. Ace of Spays does not perform surgery for retained testicles.

Color

Breed

*Friendly? (required)

Medications

*Has this pet been to our office before? (required)

Medical Information (choose at least one)

Use this space to describe health concerns

Extra Services

Highly Recommended

Prevent Licking by checking one of the two options listed here

E-collar

E-collars are the clear plastic cones that many refer to as "lamp shades." Nothing is "dog-proof" but these seem to work best.

Bite-Free Collar

Bite-Free collars look like human neck braces worn after car accidents. Not great for small dogs.

At-Home Pain-Relief

Tramadol (No Charge)

Tramadol is a conventional pain relief medication. Conventional medications are those commonly used in veterinary offices and human hospitals.

Also Available

Vaccines

Distemper-DA2PPv

Ears, Nails

Clean Ears

Rabies

Trim Nails

Must be at least 12 weeks old for a rabies vaccine.

Has this dog had a rabies vaccine in the past?

Yes No I don't know

Identification

Microchip

Fecal Exam

An injected ID # found by shelters.

Heartworm Test/Preventative

Heartworm Test Triheart Plus 6 month Triheart Plus 12 month

Flea & Tick Preventative

1 month applied 3 month supply 6 month supply

Heartworm testing is not needed for dogs under 7 months of age.

Triheart is not the best option for use in herding breeds (shelties, collies, etc).
In order for us to sell Triheart, your dog must 1) Be under 7 months old, or, 2) have a negative heartworm test at the clinic.

Advantix is a pesticide, not a drug. It is TOXIC for cats and children. Use with care.

Teeth

Call if you want retained teeth removed

Extra Surgery

Remove Hind Dew Claw(s)

Dental Scaling

Hernia Repair

This is NOT a complete dental. If you would like a full dental, please call 609-267-6770 to schedule your appointment during one of our dental clinics.

IV Fluids (Recommended for Dogs over 5 yrs)

IV Fluids

Payment Method (required): Due at the time of pick up

Cash-5% discount Credit/Debit Card Credit/Debit and Cash

Your dog will be issued a 1-year rabies license. Be sure to keep a copy of your invoice (which has the certificate on it) so that you can get a 3-year license next year.

If you would like a 3-year rabies vaccine, please bring a previous year's rabies certificate (even if expired). Without the actual paperwork, the state requireds us to issue a one-year license.

Please bring a fecal sample when you drop off your dog in the morning

We use Home Again International microchips. Your pet will be registered forever unless you contact the chip company to make changes. Microchips are NOT considered proof of ownership.

If you do not see a Thank You screen after clicking the Submit button below, please scroll back to find any required questions you have not answered and then click submit again. We will not get your information until you see the Thank You screen.

We can be reached at (609) 267-6770 if you have any questions.