Animal Medical Center

Animal Medical Center surgery Form

Please fill out our surgery form as completely and accurately as possible.

Please read carefully, sign below, and bring to appointment.

Your pet is scheduled for a procedure requiring general anesthesia. Like you, our greatest concern is the well being of your pet. We will perform a physical examination and obtain a medical history to aid in identifying any conditions that may comprimise the health of your pet. There is a risk associate with anesthesia and surgery, and we would like to take this opportunity to offer several options to make this the safest, most comfortable, and beneficial procedure for your pet.

Is your pet currently taking any medications?

Is there any history of seizures?

Multiple Choice

Pre-anesthetic Blood Profile: To aid in diagnosing systemic illness, which may alter the anestheti protocol utilized.
Dental Cleaning: Teeth are ultrasonically scaled and polished (this price is only when cleaning is done along with another surgery)
Microchip ID: To permanently identify pets
Feline leukemia/FIV test: Cats only, this is a deadly virus cats can carry.
Decline the services listed above. Please proceed with anesthesia, and contact me at this number if necessary.

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Clear Signature

Phone

Your pet(s)

Appt.Date

Services to be done

Do not feed your pet after 10pm the night before the procedure or the morning of procedure. Water is fine any time. Come in between 8-8:30am day of procedure.

Animal Medical Center

Animal Medical Center surgery Form

Please read carefully, sign below, and bring to appointment.

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