Request Your Pet’s Surgery Consultation

Fill out the form below so our surgical team can review your pet’s case.

1. Owner Contact Information

Owner Full Name *

Phone *

Email *

City/State

Preferred Contact Method *

Phone

Text

Email

Best Time to Contact *

2. Pet Information

Pet Name *

Species *

Dog

Cat

Others *

Breed *

Age *

Sex *

Female

Male

Neutered/Spayed *

Neutered

Spayed

Weight *

Optional but extremely useful for anesthesia planning:

Is your pet up to date on vaccines?

Does your pet have any known medical conditions?

3. Surgery Information

What surgery has been recommended? *

Example:

Mass removal
Foreign Body
Pyometra
Spay/neuter
Cystotomy
Eye surgery (Enucleation, Entropion, Cherry Eye)
Amputation
Brachycephalic Obstructive Airway Syndrome (BOAS) surgery
Other

Surgery Urgency *

Symptoms / Reason for Surgery *

Example:

• Lump

• Vomiting

• Injury

• Obstruction

• Infection

4. Current Veterinary Quote

What veterinary clinic provided the quote? *

City/State of that clinic *

What price were you quoted? *

Upload your quote or estimate *

5. Medical Records - critical for rush to evaluate before scheduling

Has bloodwork already been performed? *

Yes

No

Not sure

If yes, upload bloodwork results

When was the bloodwork done? *

Within 30 days

1-3 months

Over 3 months

6. Current Medications

Is your pet currently taking medications? *

Yes

No

If YES, list current medications

7. Fasting Status

Has your pet eaten in the last 8 hours? *

Yes

No

Not sure

8. Emergency Screening (Important)

Is your pet experiencing any of the following? *If yes, please call Rush Veterinary Center immediately for emergency assistance

9. Surgery Eligibility Questions

Is your pet stable and currently under veterinary care? *

Yes

No

Has a veterinarian already recommended surgery? *

Yes

No

10. Scheduling Preferences

When would you like surgery scheduled? *

Additional Notes *

Example:

• Additional symptoms

• Concerns

• Special instructions

12. Consent / Acknowledgment

I understand that: *

Rush Surgical Solutions provides surgery at least 30% lower than a verified veterinary quote

A quote and medical records must be provided to receive 30% off

I understand I may email my medical records for my pet to rushsurgicalsolutions.com

Get Affordable Surgical Care for Your Pet

Submit the form above and our surgical team will contact you to review your pet’s case and discuss scheduling.

Privacy Policy | Terms & Conditions