Please only use this form if directed to by a member of Lone Mountain Animal Hospital’s staff as this form is used to authorize us to perform surgery on your pet.

    Pet Owner Contact Information

    May we text you? (optional)

    Pet History

    Are vaccinations current? (required)

    Does your pet have a history of seizures? (required)

    Has your pet had any illnesses in the past 30 days? (required)

    Is your pet allergic to any medications that you are aware of? (required)

    Did your pet eat this morning? (required)

    I am the owner, or agent, of the above animal and have the authority to execute this consent. I hereby authorize the following procedures:

    Pet Procedure (required)

    Laser Surgery
    Laser surgery can be used on most surgical procedures. Benefits include decreased pain, swelling, and bleeding. Additional fees apply for laser use ($91).
    Yes - I want this for my pet.No - I do not want this for my pet.

    Pre-Op Blood Work
    For the protection of our patients, we recommend preoperative blood work to screen for health conditions that may represent an additional anesthetic risk.
    Yes - I want this for my pet.No - I do not want this for my pet.

    HomeAgain Microchip
    Yes - I want this for my pet.No - I do not want this for my pet.

    Certain procedures can cause some degree of pain and/or discomfort. Pain medication will be administered to patients whenever appropriate. Reasonable precautions will be used against injury, escape, or death of this pet. All anesthetics do present a risk to the health of my pet. I accept these risks as part of the procedure(s). I realize that the results cannot be guaranteed, and that payment is due in full at the time of discharge. By signing below, I indicate that I understand and agree to the above information.

    Pet Owner's Signature (required)

    Today's Date (required)


    Lone Mountain Animal Hospital to provide quality veterinary care with personal touch embrace compassionate progressive approach to needs of our patients.

    We accept CareCredit as a form of payment.

    Business Hours:
    Mon-Sun 7:00am – 6:00pm

    Contact Us:

    Phone: 702-645-3116
    Fax: 702-645-2758
    6688 W. Cheyenne Ave. Las Vegas, NV 89108

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    Payment Options:

    Check (with Photo ID)
    CareCredit (Card and PayMyProvider)
    Trupanion Payments