PetDesk (Existing Clients)
Payment Options

reception.sternerclinic@gmail.com

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About
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Contact
Request Appointment

Dental/Surgery Release FormSterner Veterinary Clinic

Dental/Surgery Release Form

Pet's Name *

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Species

Age

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Sex

Breed

Color

Client account

Owner’s name *

First

Last

Owner's Email

Owner’s phone *

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Check in temp

Current weight

Procedures to be performed: (Routine cleaning/polish/extractions)

Checkboxes

Charges
Called

Animal Alert:

Prior to anesthesia, your pet will receive a full physical exam. Pre-anesthetic blood work is recommended and will be completed before anesthesia to evaluate the overall health of your animal.

Pre-anesthetic Blood Work $55.00

Approve
Decline

Intravenous Catheter and Fluids

Approve
Decline

Under 35lbs-$70.00/ 35lbs and over $80.00

Dental x-rays

Approve
Decline

$100 Canine Full Mouth/$75 Feline Full Mouth

Dental extractions - Price Variable

Approve
Decline

Post Operative Pain Medication to go home

Approve
Decline

Pain medication in hospital included with surgery

Histopathology - $143

Approve
Decline

E-Collar to go home -$10.00

Approve
Decline

Ace/Morph/Hydro or Ket/Val or Keto or Propofol

Ace/Morph/Hydro
Ket/Val
Keto
Propofol

Ace/Morph/Hydro

Ace
Morph
Hydro

Ket/Val

Ket
Val

Isoflurane or Glyco or Polyflex or SQ Fluids

Isoflurane
Glyco
Polyflex
SQ Fluids
Other

If Other, Please Specify

Buprenex/Simbadol or WaterBottle(<99°F) or Postop temp

Buprenex/Simbadol
WaterBottle(<99°F)
Postop temp

Buprenex/Simbadol

Buprenex
Simbadol

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Start:

Anes

SX

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End:

Anes

SX

Checkboxes *

I authorize the above named procedure to be performed at Sterner Veterinary Clinic. The nature of such service has been described to me to my satisfaction. I realize that dangers of anesthesia and surgery include, but are not limited to, hemorrhage, infection and even death. No guarantee can ethically or professionally be made regarding the results or cure. I understand that I assume financial responsibility for all services rendered, and that payment is due on the date of surgery. During non-business hours, no veterinary personnel will be on the premises.

Signature

Date (No Appointment)

Phone numbers where you can be reached on the day of surgery

Dropdown

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Cell

Home

Email *

To be used for reminders

Dental Options Waiver

Checkboxes *

I have read and agreed the above mentioned policy

Pre-operative Blood Work ($50)

Accept
Decline

Intravenous Catheter/Fluid Therapy ($57<35lbs/$73>35lbs)

Accept
Decline

Digital Dental Radiographs ($100 canine full mouth and $75 feline full mouth)

Accept
Decline

Signature

Date

Request an appointment

Ionia, MIAppointments

We currently serve the communities of Ionia, Portland, Greenville, Sheridan, Stanton, Westphalia, Saranac, Lake Odessa, Lyons, Muir, Carson City, and the surrounding areas. Existing clients may request an appointment by phone, or by using our PetDesk app! PetDesk makes caring for your pet easier with quick access to medical records, appointment requests, refill requests, and more!

Request Appointment Download App

Questions?We're here to help.

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Where to Find Us

575 Apple Tree Drive

Ionia, MI 48846

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How to Reach Us

P: 616-527-3320
E: reception.sternerclinic@gmail.com

Please Note: This email is only monitored during business hours. Please allow up to 24 hours or the next business day for a response.

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Our Hours

By Appointment Only

Monday: 7:30 am to 7:00 pm
Tuesday – Friday: 7:30 am to 5:00 pm
Saturday – Sunday : Closed

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