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Pre-Operative Questionnaire

Please fill out this form and return to us at least 24 hours prior to your pet’s procedure.

Please select your primary hospital location? *

Which location is your procedure scheduled at? *

Name *

Name

First

Last

Phone *

Email *

What is the name and phone number we should call during the procedure(s)? *

Pet & Procedure Information

Pet's Name *

What procedure is being performed on your pet?

Has your pet experienced any coughing or sneezing in the past 7 days? *

Yes

If yes, please explain

Has your pet experienced any vomiting or diarrhea in the past 7 days? *

Yes

If yes, please explain

Do you have any specific requests for the surgeon? *

Yes

If yes, please explain

Would you like to be contacted by our surgical team to discuss anything prior to your pet’s procedure? *

Yes

Preferred Date #1 *

Preferred Date #2

Preferred Date #3

Is your pet taking any medications, supplements and/or special foods? *

Yes

Please list all medications (include name, dosage, and frequency), supplements (include name, dosage, and frequency), and/or special foods (brand, amount fed, and frequency)

Does your pet have any allergies to any food or medications we should be aware of? *

Yes

Please list all allergies we should be aware of

Do you need a refill of any medication and/or preventatives? *

Yes

Please list the name and dosage of any medication/preventatives you would like refilled.

Have you completed the estimate via DocuSign or in person? *

Yes

If no, please explain

Add Another Pet's Procedure(s) Remove

Fasting

I understand that my pet(s) must be fasted prior to the procedure unless otherwise directed by the veterinarian. No food after midnight (12:00 AM). Water is allowed. *

I understand

I have additional questions

Please elaborate

Acknowledgements

RECOVERY

Procedures happen between 10 am and 4 pm. The doctor will call with an update as soon as your pet is recovering from anesthesia.

ANESTHESIA

To mitigate risks associated with anesthesia, we perform preoperative testing, examinations, and customized anesthetic plans for every one of our patients. An intravenous catheter will be placed, and all necessary medication and pain management will be administered to ensure your pet is comfortable.

During the procedure, we use the highest quality anesthesia and monitor your pet's temperature, heart rate, blood pressure, and oxygen level in the blood; while delivering IV fluids to help keep the blood pressure stable and expedite recovery. In the rare event your pet experiences an adverse reaction to any medication or anesthesia, every effort will be made to revive and sustain your pet’s life unless otherwise specified.

Throughout recovery one of our nurses will remain with your pet, ensuring they are kept warm and comfortable. After a routine recovery, the surgeon will call you with an update and schedule a discharge time which is typically between 3-5:30 pm.

I hereby understand the risks associated with general anesthesia and have been advised as to the nature of this procedure to be performed. I understand also that there is always a risk associated with any anesthesia episode, even in apparently healthy animals, and have discussed my concerns with the veterinarian.

Signature *