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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 *

First

Last

Pet Name *

Email *

Phone *

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. 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 $107.50
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. If negative we will discuss heartworm prevention. *

I approve the heartworm test for $64.75
I decline the heartworm test

All CATS should be tested for feline leukemia & 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/fiv test for $115.50.
I decline the tests.

Some surgeries require an overnight stay, please note our facility is not staffed during non-operating hours. I consent to knowing that my pet will be unattended during non-operating hours. Please note our building is not equipped with a fire protection sprinkler system.

Microchip Identification System Cost $55.00 *

greatest vaccinated your

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.

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South Arlington Animal Clinic

Pre-Anesthetic Form

Pre-Anesthetic Form

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