Pre-Anesthetic Blood Testing Information Form

We have put together this packet in order to make surgery day as easy and stress-free as possible. It is required you print and initial the last two pages if your pet is undergoing surgery.

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Pre-Anesthetic Blood Testing Information Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet before your visit.

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PRE-ANESTHETIC BLOOD TESTING INFORMATION FORM

PLEASE READ CAREFULLY

Dear Client,

Our greatest concern is the well-being of your pet. Before putting your pet under anesthesia, we routinely perform a full physical examination.

We also highly recommend and sometimes require that a Pre-Anesthetic Blood Profile be performed on all pets’ undergoing anesthesia to maximize patient safety.

The Pre-Anesthetic Blood Profile helps alert our surgeon to the presence of dehydration, anemia, infection, diabetes and/or kidney or liver disease that could complicate the procedure. These conditions may not be detected without a pre-anesthetic profile thus not allowing for the most appropriate and safest anesthetic regime to be administered. These tests are similar to those your own physician would run if you were to undergo anesthesia. In addition, these tests may be useful if your pet’s health changes to develop faster, more accurate diagnoses and treatments.

The Authorization Form you will sign on your pet’s surgery date at our office will offer pre-anesthetic blood work.

1. The Quantitative Blood Count (QBC) and Pre-Anesthetic Profile which includes:
  - CBC: PCV (Anemia), White Blood Cell Count (Infection) & Red Blood Cell Count (Anemia/Bleeding Disorder), Platelet Count (Clotting Disorder)
  - Profile: BUN and Creatinine (Kidney), ALKP and ALT (Liver), Glucose (Sugar), Total Protein (Dehydration), and Electrolytes (Imbalance)
2. Owner Elects to Decline the recommended pre-anesthetic blood tests at this time but requests that we proceed with the procedure. This is indicated by NOT checking the optional procedures. You will notice other tests available that are not included in the above choices. We have selected tests that give the doctors a suitable overview of healthy patients. However, if the patients are in their senior years (above 7 years old) or are sick, the FULL senior profile can be done the day of the procedure at the owner’s request. It has been included in the high amount estimate.
  
  For feline patients, our feline owners will see an option for a FeLV/FIV Test. We highly recommend this test be performed on all feline patients at least once in their lives because Feline Leukemia and Feline Immunodeficiency Virus (Feline Aids) are viruses for which no cure exists. If your pet goes outside, we recommend administering the Feline Leukemia vaccine as well. Please ask questions if you would like to learn more about Feline Leukemia and Feline Aids.
  
  We realize surgery and anesthesia are scary for both the owner and patient and we attempt to make surgery day as safe and comfortable for all involved. The physical examination and blood work done prior to any surgical procedure allows us to best minimize anesthetic and surgical risks and maximize patient safety.
  
  If you have any questions or hesitations about the scheduled procedure, please do not hesitate to call us to discuss any aspect of the upcoming procedure.