Van Zandt Animal Care Center
21449 Hwy 80
Wills Point, Texas 75169
903-873-4100
Anesthetic Release
By signing this form, you are allowing us to perform sedation and/or general anesthesia, and understand the risks associated with it.
We recommend a blood profile to ensure that your pet is in a low risk category prior to anesthesia. The latest technology has enabled
us to run safe and accurate blood chemistries minutes before anesthetic induction. These tests are similar to those your own physician
would run were you to undergo anesthesia. In addition, the results of these tests will serve as reference values for future use should
your pet become ill.
Intravenous (IV) catheters and intravenous fluids are important to maintain blood pressure while under general anesthesia. IV
catheters and IV fluids are routinely used for the vast majority of human surgeries. If your pet is admitted for spay and is in
heat/pregnant the IV catheters and fluids are required at the indicated cost below.
For these reasons, we highly recommend blood screening before such procedures and IV catheters and fluids during the procedure.
Our laboratory is fully equipped and staffed to perform these important blood test. Results will be immediately available to examine
before anesthesia and/or surgery. PLEASE INDICATE YOUR CHOICE BELOW BY PLACING YOUR INITIALS:
7 years and younger
8 years and older
Pre-anesthetic blood screen
Yes ___ No ___
$69.00
$83.68 (required)
IV catheter and fluids
Yes ___ No ___
$39.90
$39.90 (required)
Microchip
Yes ___ No ___
$39.00
same
Heartworm Test(dog)
Yes ___ No ___
$32.00
same
Felv/Fiv Test (cat)
Yes ____ No ___
$52.00
same
* IV catheters/fluids and blood screens are REQUIRED for all patients 8 years of age and older.
*Every patient is administered analgesics (pain medication) to take home after the procedure.
Signed: ____________________________________________ Phone #___________________________
IN ORDER TO KEEP OUR HOSPITAL FREE OF PARASITES, ANY ANIMAL FOUND WITH FLEAS, TICKS, OR INTERNAL PARASITES, WILL BE TREATED
UPON ARRIVAL AT OWNER’S EXPENSE.
Witness: _______________
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