FELINE PRE-ANESTHETIC CONSENT FORM
Please read carefully and sign.
Like you, our greatest concern is the well-being of your pet. Your pet is scheduled for anesthesia and/or
surgery. Before putting your pet under anesthesia, we will perform a full physical examination. However, we
also recommend performing a pre-anesthetic blood profile so that we can maximize the patient's safety. This
will alert the doctor of any abnormal chemistry values, such as dehydration, kidney disease, liver disease,
diabetes. The presence of these conditions could complicate the procedure. These conditions may not be
detected unless a pre-anesthetic profile is performed. Additionally, the results of profile may be used later to
develop fast, more accurate diagnoses and/or treatments in the future. State of the art equipment allows us
to perform these pre-anesthetic blood profiles within the clinic, and we are committed to making this
technology available to your pet.
PRE-ANESTHETIC BLOOD PROFILE
Includes: 10 blood chemistries, electrolytes, and complete blood count
Please complete the pre-anesthetic blood profile prior to surgery on my pet.
COST $69.00
Signature of Owner
FELINE LEUKEMIA/ FIV TEST, FOR ALL CATS AND KITTENS NOT PREVIOUSLY TESTED
Feline leukemia virus (FeLV) is one of most common and destructive of all cat viruses. Of cats
persistently infected, about 25% die within 1 year and 75% within 3 years. Some may live a normal life
but will tend to have chronic illnesses. Currently, there is no effective treatment for cats infected with
FeLV. We suggest that cats be tested prior to surgery and initial vaccinations.
Please complete the feline leukemia/FIV test prior to surgery on my pet.
COST $35.00
Signature of Owner
REFUSAL OF BLOODWORK
I have elected to refuse the recommended bloodwork at this time and request that you
proceed with anesthesia. I assume full financial responsibility for this/ these animal(s). I understand
that there is always a potential risk when using anesthesia or performing surgery.
Signature of Owner
FELINE PRE-ANESTHETIC ADDITIONAL FORM
PAIN MEDICATIONS
I would like for my pet to have only the post-op pain medication for pain relief that lasts for
24 hours following surgery.
COST $17.00
I would like for my pet to have the pain relief package, which includes a pre-op pain
medication, a post-op pain medication, as well as a 3 day supply of take-home pain medication.
COST $26.00
I would like for my pet to have therapy laser treatment.*
COST $12.00
*Laser therapy treatment has been scientifically proven to be successful in
treating post-surgical pain. Laser therapy reduces pain and inflammation and
increases the rate of healing.
ADDITIONAL OPTIONS
I would like for my pet to have Sevoflurane, the safest gas anesthesia available to veterinarians.
COST $30.00
I would like for my pet to have an IV catheter and fluids during his/ her surgical procedure.*
COST $38.00
*Fluids during anesthesia will reduce the risk of low blood pressure. The
placement of a catheter also helps us quickly administer life-saving drugs in case
of an emergency.
I would like for my pet to have a Home Again Microchip.
COST $46.00