ANIMAL CLINIC OF GRAND PRAIRIE
SURGICAL CONSENT FORM
PRE-ANESTHETIC BLOOD TESTING
Like you, our greatest concern is the well-being of your pet. Before putting your pet
under anesthesia, we will perform a physical examination. However, many conditions,
including disorders of the liver, kidneys, or blood are not detected unless blood or urine
testing is performed. Such tests are especially important before any kind of surgery.
For these reasons, we highly recommend blood and or urine testing before such
procedures. Your pet’s veterinarian may recommend specific tests, in addition to routine
screening, that are appropriate for the age and condition of your pet. Your pet’s doctor
will discuss any additional fees involved.
Our laboratory is fully equipped and staffed to perform these important tests. Results
will be available to evaluate before the procedure.
(
) YES, I want my pet to have a
pre-surgical blood screen.
< 3 Years of Age - $56.00
> 3 Years of Age - $80.50
(
) YES, I want my pet to have
a pre-surgical urine screen.
$27.50
We are committed to providing the highest level of comfort for your pet. If you choose not to
have medications prepared for your pet’s post-operative pain management, please initial here ____.
In most instances the cost for this medication will be less than $35.00.
*If you would rather not medicate but prefer a post operative cold laser treatment to diminish pain,
reduce swelling and enhance healing time. Cost is $34, initial here _____.
I consent to, and agree to pay in full for all services requested and rendered, including any deemed
necessary by the Veterinarians for medical or surgical complications or any unforeseen
circumstances.
Signed: _______________________________________
Owner or agent
Date: __________________
Phone number you can be reached between 9a.m. and 6 p.m. today ______________________
If you are interested in a text message post-surgery please leave your phone number_____________
* There may be an additional charge if your pet is in heat or pregnant.