Surgery/Dental Patient Confirmation Form

Save time at your pet’s procedure by completing our online patient confirmation form.

Surgery/Dental Patient Confirmation Form

Please download or fill out this form as completely and accurately as possible before your visit.

2901 Highway 37 East Toms River, NJ 08753

732-270-0100

We will prepare a Quote for you & send to your email for approval, we do not do verbal quotes.

What to do to prepare:

It is imperative that after 10pm the night before and the morning of the surgery there is NO Food or Drink AT ALL, given to the pet.

Please be advised that your pet will be with us for the day. Pick up time is at 5:00pm unless we arrange a different time with you on the procedure day. At pickup you will receive instructions for post-surgery care for your pet. Please plan on being home that evening to monitor your pet.

When scheduling your surgery/dental we will charge you a $100 reservation fee, that will be applied to the set date and time listed above.

What to do if you should have to reschedule your surgery/dental:

We are happy to RESCHEDULE greater than 8 days prior to the above date, but you must call and verbally speak to us so that we can make alternate scheduling arrangements and move your $100 reservation fee to your new date. If you CANCEL with greater than 8 days prior to the above date we will refund your $100 reservation fee, to your original form of payment.

Consequences of canceling/rescheduling without a minimum 7 days notice:

Please be advised that it is very difficult for us to find another patient with a flexible schedule to fill your surgery/dental date/time slot at the last minute (7 days or less). When you cancel last minute that prevents that surgery/dental time from being spent on another pet that is in need. If your surgery/dental is cancelled/rescheduled with 7 days or less notice, Coastal Veterinary will keep your $100 reservation fee.

Confirming your Surgery/Dental:

We use cellphone and email to confirm your surgery appointment. Please respond to both cellphone and email so that we know you are CONFIRMING you will be here at the above scheduled date & time. You MUST confirm your Best contact information by filling in below.

Best Contact Information for confirmations and day of procedure & email for Quote:

If you wish to be on our move up list for a sooner date, please let us know your availability.

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