Hospitalization Consent Form

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Hospitalization Consent Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. If this is an emergency, or if your pet needs urgent care, please call us at 530-343-3516 for a faster response.

Medical Information


I certify that I am the owner, or authorized agent for the owner, of the above animal. I hereby consent to and authorize the doctors and staff at Chico Creek Animal Hospital to admit this pet, perform the above described procedures, and administer medications, anesthesia, surgical procedures, tests and or treatments that the doctors deem necessary for its health, safety and well being while under their care and supervision. I have been advised of the nature of the procedures and the potential risks and benefits. I understand that veterinary medicine is an inexact science and that no guarantee of succesful treatment can be made.

I acknowledge that I am responsible for payment in full for the above procedures and treatments at the time my pet is discharged.

Phone number to be reached at in case of an emergency
Phone number to be reached at in case of an emergency
Phone number to be reached at in case of an emergency

Pre-anesthetic screening tests

If your pet is undergoing an anesthetic procedure, rest assured that advances in anesthesia, anesthetic monitoring, and surgery have made procedures safer with a low rate of complications. Nevertheless, some obscure conditions can be detected only by diagnostic testing. Because of this, we recommend pre-anesthetic screening tests:

That includes a Chem 10, CBC, and Electrolytes. The cost is $122.75

We recommend IV Fluids be administered during anesthetic procedures. The fluid therapy helps to maintain proper blood pressure while under anesthesia and it also helps with the recovery from anesthesia. The cost of surgical IV fluids is $53.50

Retained Deciduate

Small breed pets often suffer from retained deciduate (baby) teeth after their adult teeth grow in. This condition creates overcrowding of teeth, retention of food or other debris between the teeth, and tartar buildup. This, in turn, leads to bad breath and damage to gums and adult teeth. We strongly recommend that these deciduate teeth be extracted while your pet is under anesthesia to avoid future complications. The cost for this procedure varies based on the number of teeth extracted and the time spent on extractions.


Microchipping pets involves inserting a tiny rice-like microchip under your pet's skin. This chip then holds your pet's identity for life. If your pet is ever lost and a local shelter or veterinary practice finds it, the law requires that all pets be scanned for a microchip before they are adopted out or euthanized. The cost for this procedure is $44.00