South Arlington Animal Clinic

Pre-anesthetic Form

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Pre-anesthetic Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

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CLIENT NAME/PET *

Email *

SURGERY/TREATMENTS: *

At South Arlington Animal Clinic, our greatest concern is the well-being of your pet. Before putting your pet under anesthesia, we perform a full physical exam, which is included in your surgery fee. In order to maximize patient safety, we HIGHLY recommend and sometimes require, a pre-anesthetic blood profile. The simple tests give us a quick look at the complete blood count to assess anemia, infection, and some cancers; organ functions, which include kidney, liver, blood sugar, dehydration, and electrolytes. These results allow for the most appropriate and safest anesthetic regime to be administered. *

I approve the pre-op tests for an additional $95.00
I decline the pre-op tests.

Other factors can affect the safety of today's procedure and should be current with your pet.

All DOGS should be on heartworm prevention and have been tested in the last 2 years. If not, a test should be performed before your pet is anesthetized. *

I approve the heartworm test for $59.00
I decline the heartworm test

All CATS should be tested for leukemia AND or feline FIV/AIDS, especially if your pet is recently adopted, or if the cat goes outside and is not vaccinated for this disease. *

I approve the leukemia test for $76.75
I approve the leukemia/fiv test for $104.00
I decline the tests

MICROCHIP IDENTIFICATION SYSTEM COST $49.60 *

If both the pre-op AND heartworm/leukemia tests are performed, you will receive 15% off both the tests. We realize surgery and anesthesia are scary for both the family and pet. We strive to make surgery day safe and comfortable for all as there is always a risk with anesthesia and surgery. These tests allow us to minimize surgical risks and maximize patient safety. *

I have read and understand.

Signature

Phone *

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We proudly serve the pets of Arlington, Grand Prairie & Mansfield, and surrounding areas. We look forward to seeing you and your pet! Request an appointment by clicking the button below.

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