Tri-State Veterinary Center Pre-Surgical Form

Client

Phone

Animal

Email

Patient

Age

Types of Surgery

Spay

Neuter

Declaw Front

Mass Removal

Dental

Number of Masses

Location of Masses

Other

Dental procedres that have teeth extracted will receive pain medicine. All loose teeth will be extraced. If a tooth needs to be surgically removed, we will call you before removing it unless you initial below. No need to call if a tooth needs to be surgically extracted.

Initial

Please Answer the Following Questions.

Has your pet been fed in the past 12 hours?

Have you noticed any changes in your pet's water consumption?

Have you noticed any changes in you pet's urinary habits?

Is you pet allergic to any medication?

Is you pet currently taking any medication?

Is there any reason your pet would be a poor surgical risk?

If you answered yes to any questions please explain:

Pre-Anesthetic Testing:

To ensure your pet can properly process and eliminate an anesthetic. Your veterinarian may recommend laboratory testing to confirm that your pet’s organs are functioning properly and to find hidden health conditions. The type of testing is based on your pet’s breed, age, and sex. Please ask your veterinarian which test is right for your pet.

To Go Home

Would you like your pet to be sent home with pain medications?

Would you like an Elizabethan collar

Other:

Would you like your pet micro chipped for $60.00?

If masses are removed, do you want them sent for analysis?

Date:

Monthly Shot Clinic