*Please bring this completed form with you the morning of your pet’s surgery.

Owner's Name *

Email *

Pet Name *

Procedure(s) Planned

If we are removing a tumor or growth, please describe its location

Are there any additional non-surgical procedures you’d like us to perform while your pet is under anesthesia? (Please note, there may be an additional charge if not included on estimate)

Nail trim (no additional charge)

Ear cleaning ($25)

Anal gland expression ($19)

Microchip ($45)

Other…

Has your pet had any issues or concerns recently? Examples include vomiting, diarrhea, weight loss, anorexia, seizures, etc.

When did your pet last eat?

To the best of your knowledge, has your pet experienced any previous anesthetic complications? Or is this their first time under anesthesia?

Does your pet have any allergies?

What medication(s) is your pet currently on? Please include the last time each medication was administered

Do you need any medication refills? This may also include monthly preventatives for fleas/ticks and heartworm

Do you have a preference for medications to go home?

Liquid

Tablet/Capsule

Either

*Please note: For larger dogs, liquid medications may be much more expensive than tablets/capsules.

For small dogs, certain medications may only be available in liquid form.

We will adhere to your preference as much as possible; some medications are only available in specific forms.

Our surgical team highly recommends the use of an Elizabethan collar (a “cone”) at home for at least 2 weeks post-op. This prevents your pet from being able to lick/chew at an incision along their body as well as kick/scratch at their face/head.

Send my pet home with one today

I already have one at home

Practice / Location

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Client Pre-Surgical Questionnaire

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