Download Our App

Family Pet Health Care

Your Other Family Doctor

Request An Appointment 3623 Indian Hills Road SE
Decatur, AL 35603

(256) 341-0200

Menu
  • Home
  • About
    • Dr. Dawn True
    • Dr. Ingram Stephenson
    • Dr. Berschneider
    • Hospital Tour
  • Clients
    • Request An Appointment
    • Forms
    • Payment Options
    • Get The App
  • Services
  • Home Delivery
    • Vetsource
    • Purina Pet Food
  • Wagworthy Tales and News
    • Adoptions
    • H.O.P.E.
  • Contact

Anesthesia Consent Form

"*" indicates required fields

Step 1 of 2

50%

FAMILY PET HEALTH CARE ANESTHETIC CONSENT FORM

Are vaccinations current?
Update today?
Is your pet on heartworm prevention?
Test today?
Did your pet eat this morning?
Is your pet allergic to any drugs that you know of?
Has your pet had any accident or illness is the last 30 days?
Is your pet currently on any medication?
Any other specific problems to be checked?
Any dental hygiene products used on a regular basis?

Elective Procedures:

Options
We strive to keep a pest free environment for your pet so we require that any internal parasites (worms) or external parasites (fleas and ticks) identified on your pet will be treated at owners’ expense.
I _____ authorize a Post Surgical Pain Injection at a cost of $22 to $55.00*
I _____ request the ADDITIONAL PAIN MEDICTATION at the time my pet is discharged from the hospital at the cost of $12 to $20 This is an additional medication to make my pet more comfortable at home for the next 24 to 72 hours after surgery.*
You are to take all responsible precautions against injury, escape, or death of my pet. I understand that anesthesia and surgery always involve some risk to my pet (such as unknown internal physical abnormalities, medication allergies, surgical complications, internal bleeding, shock, incision dehiscence, & post-surgical infections) and I agree to hold you harmless, in the absence of negligence, in connection with these procedures. I acknowledge that no guarantee or assurance has been made to me as to the results that may be obtained. In the event, complications arise and I cannot be immediately contacted at the below-listed phone number, you are directed to make the decision you deem fit best for my pet. I agree to pay for the services rendered. I have read the foregoing, understand what it says, and agree.
MM slash DD slash YYYY

Family Pet Health Care

Pre-Anesthesia Blood Screen Consent Form

“Because We Care”

We recommend a pre-anesthesia blood chemistry panel on all pets prior to anesthesia. Most drugs are removed from the body by the liver and the kidneys, therefore it is important that these organs are healthy. It is also important that patients have normal blood counts to promote proper tissue healing. The following tests are included in the pre-anesthesia blood panel:

  1. CBC-Complete Blood Count-WBC, HCG, PLT
  2. SGPT/ALT-Detects liver damage
  3. Total Protein-Liver function test
  4. BUN-Kidney function test
  5. Glucose-Blood sugar level to detect diabetes

The cost for this profile is: $88.69

If any of these results are abnormal, we will discuss our findings with you and may decide to do one of the following:

  1. Postpone the anesthesia procedure until a later date
  2. Further testing to pursue a specific diagnosis
  3. Proceed with anesthesia, but alter the drugs and procedures

If all tests are normal, it does not guarantee that your pet will not have an anesthetic reaction, but it does tell us that your pet is healthy and in the low-risk category. If you have any questions regarding the blood panel or anesthesia please ask our staff and the doctor will be happy to answer them.

Initial
This field is for validation purposes and should be left unchanged.

Family Pet Health Care

(256) 341-0200 3623 Indian Hills Road SE
Decatur, AL 35603
Office Hours

Monday, Wednesday, Friday: 8:00AM – 5:00PM
Tuesday, Thursday: 7:00AM – 6:00PM
Saturday, Sunday: Closed

For after hours and weekend emergencies, we encourage you to contact:

© 2023 Family Pet Health Care | Sitemap | Accessibility | Website by DOCTOR Multimedia

Call Us Text Us
Skip to content
Open toolbar

Accessibility Tools

  • Increase Text
  • Decrease Text
  • Grayscale
  • High Contrast
  • Negative Contrast
  • Light Background
  • Links Underline
  • Readable Font
  • Reset