Pre-Anesthetic Care Form

Please complete this form before your pet’s dental procedure.

Owner's Name *

First

Last

Email *

Pet's Name *

Pre-Anesthetic Bloodwork

To ensure your pet’s safety during anesthesia, we recommend pre-anesthetic bloodwork that will assess organ function, clotting ability, infection, and anemia. We will also be looking at hydration status, kidney and liver function, diabetes precursors, and a complete cell count. This is recommended for all patients, but especially those 7 years of age and older. *

I would like the basic comprehensive pre-anesthetic bloodwork panel (ChemPlus/CBC: $168)
I would like the comprehensive pre-anesthetic bloodwork panel with thyroid value (ChemPlus/CBC/T4: $220)
I would like the senior wellness panel (ChemPlus/CBC/T4 and Urinalysis: $235)
I accept the risks involve with sedation/anesthesia and decline any pre-anesthetic testing

Intravenous Fluid Therapy

Intravenous fluids aid in controlling blood pressure, blood loss, supports renal function, and speeds recovery. It is especially important in patients with kidney disease and required for patients over 7 years of age. *

I would like my pet to receive intravenous fluid therapy ($102)
I accept the risks involved with not offering supportive fluid therapy and decline this service for my pet

Oral Radiographs

Radiographs allow us to view structures below the gumline that we are not able to see on a visual oral assessment. They can help determine the overall health of diseased teeth, aid doctors in extraction strategies, and confirm any canal exposures, abscesses, bony changes, and resorptive lesions present. *

I would like my pet to receive full mouth radiographs ($95)
I approve a radiograph only if needed for a diagnosis at a single tooth. ($28-56)
I understand why radiographs are recommended and decline this service for my pet

Signature *

Date *

Phone *