Feline/Canine Anesthesia Consent Form

Things to know before you drop of the cat/dog for the surgery. Pre workup needed to be done before the surgery.

Blood Work:

Pre – Operative Chemistry and Complete Blood Count:

______ Accept                                    ______Required                     _______Declined

Super Chemistry and Complete Blood Count: REQUIRED FOR PETS 6 YEARS AND UP.

______Accept                         ______Required                     _______Declined

Blood Pressure Monitoring:

REQUIRED FOR PETS 6 AND UP

______Accept                         ______Required                     _______Declined

Fluid Therapy:

Intravenous Fluids: REQUIRED FOR ALL PETS 6 YEARS AND UP.

______Accept                         ______Required                     ______Declined

Additional Medications:

Extra Pain Medication

______Accept                         _______Required                   _______Declined

Convenia Antibiotic Injection

______Accept                         _______Required                   ________Declined

Flavor X

______Accept                         _______Required                   _______Declined

Dental Options:

Extractions range from $ 25/tooth - $85/tooth (depending on difficulty)

______$100    ______$200    _____Any Amt      ______Call First     ______None

Baby teeth: $20/tooth

______Accept             _______Decline          ________Not Applicable

** If for some reason we are unable to reach you during the procedure to authorize extractions, we will wake your pet up and no extractions will be done.

Preventive Medicine:

Rabies Vaccine: Required for all dogs.

_____1 year                _______ 3 Year          ________Up to Date

Canine Distemper Vaccine: Required

_______Needed                     _______Up to date

Bordetella Vaccine (Kennel Cough): REQUIRED

_______ needed                     ________Up to Date

Fecal Float: REQUIRED

________Needed                   _________ Up to Date

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