Surgical Check-In Form

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Your Name

Your Phone Number

Your Email

Your Pet's Name

Age

Breed

Procedure

VACCINATIONS REQUIRED FOR SURGICAL PATIENT
Canine-Rabies, DHLPP, Bordetella, Heartworm Test, and a fecalFeline- Rabies, RCP, and a fecal

Our most important priority is the health and well-being of the animals and the safety of our employees. For this reason, we reserve the right to decline surgical procedures on any animal that is not current (within the last 12 months) on vaccines. NO EXCEPTIONS.

 
PRE-SURGICAL BLOOD ANALYSIS

Routine pre-surgical analysis of blood has been a procedure in human medicine for many years. As veterinary medicine has advanced, we now have the capability to properly evaluate your pet’s health. This blood analysis also can help to evaluate your pet’s ability to utilize and metabolize drugs and anesthetics. The detection of underlying problems before surgery is even more important since our patients cannot always tell us how they feel.

The tests we recommend evaluate the major organ functions and other common problems at a particular stage of life. While the performance of these tests does decrease surgical anesthetic risk, they do not detect all potential problems or eliminate all surgical and anesthetic risk. They do not guarantee results or a cure.

REQUIRED TEST

We require a pre-surgical blood panel that will provide the doctor with important information as to the current health status of your pet. Our pre-surgical blood analysis will cover ALP (liver), ALT (liver), BUN (kidney), Creatinine (kidney), Glucose (diabetes), total protein, and PCV. PRE-SURGICAL BLOOD WORK IS REQUIRED FOR ALL PATIENTS. ANY EXCEPTIONS WILL BE DETERMINED BY THE DOCTOR.

My pet is on medication

What type?

Last dose given

I withheld food/water past midnightMy pet is not showing signs of illness at home (vomiting/diarrhea, coughing/sneezing)I authorize implantation of a Microchip - $50I authorize a nail trim to be done under anesthesia - $15I want a histopathology(for mass removals) done - $120+

Owner/Agent Name

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