Pre-anesthetic Blood Work Consent

Pre-anesthetic Blood Work Consent

Same day as the anesthesia
Greenbank Animal Hospital

Nepean Rideau Veterinary Professional Corportation

3160 Greenbank Rd

Ottawa, On K2J 4H6

613-825-2902
Your pet is scheduled for a procedure that requires anesthesia/sedation. As previously discussed, it is recommended to have preanesthetic blood work done. Completion of this form states that you acknowledge the risk and would like to proceed with anesthesia/sedation without blood work. If you decide you would like to proceed with blood work, please call the clinic at 613-825-2902.

Geriatric pets: All pets over 7 years of age are considered geriatric. Due to the higher incidence of diseases in this age group, the risk of anesthesia related problems is increased. In order to mitigate these risks, all geriatric patients are required to have preanesthetic blood testing.
Client Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Pet's name*
Pet's date of birth
Surgical procedure being done*
Date of pet's surgery (or anesthetized procedure)?*

MonthDayYear
The preanesthetic profile is checking the highlights of liver, kidney, red cell count, white cell count, and platelets.*

I DECLINE the recommended pre-anesthetic tests at this time and request that you proceed with the anesthesia. I understand that a medical condition may exist which would be impossible to identify during a physical examination alone. I understand that my pet's health could be at risk if such a condition goes undetected when my pet is placed under anesthesia.
Please verify that you are human*
Should be Empty: