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Lawndale Veterinary Hospital Surgery/Dental Information Form.
Name: *
Your answer
Pet's Name: *
Your answer
If we need to contact someone to make financial decisions, who should we contact? *
Your answer
Best Contact Number for us to reach you: *
Your answer
Which method is it best to contact you? *
Species: *
Breed? *
Your answer
Age? *
Your answer
Sex: *
What Surgical Procedure is your pet having done? *
Your answer
Please select any other service you would like performed today:
Is your pet taking ANY medications? (Including supplements, vitamins, or over the counter meds such as aspirin)? Please list any medications below.
Your answer
Do we need to give any medications while your pet is with us?
If yes to previous question, please list name of medications and when they need to be administered.
Your answer
Has your pet ever had any adverse reactions to procedures, vaccines, and/or medications? If yes, please describe below:
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Pre-anesthetic bloodwork for all patients 8 years and older is REQUIRED, but is also strongly recommended for any pet going under anesthesia. This checks basic organ functions (kidney and liver) and complete blood count (red blood cells, white blood cells, platelets). Cost of this is close to $77.00. Would you like your pet to have pre-anesthetic bloodwork before their procedure? *
If any additional diagnostic labwork such as urinalysis, and/or x-rays are recommended by your pet's doctor, may we go ahead with them? *
If your pet is having a professional dental cleaning performed, do you give us permission to extract teeth as needed? There is an additional cost for extractions.
If your pet is having a professional dental cleaning performed, do you give us permission to perform dental radiographs as the doctor deems necessary? There is an additional cost for dental radiographs (~$80.00).
A small amount of hair may be shaved on a leg of my pet, so that and IV catheter can be placed before surgery. Please type your initials below to indicate you have been made aware of this. *
Your answer
If further problems are detected while your pet is under anesthesia, how should we proceed? *
Required
If you would like us to call you before additional treatments please indicate below how we may proceed if you cannot be reached immediately. *If you authorized treatment as recommended by your pet's doctor in the previous question please skip this question.*
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