Surgery History Form
Please complete this form before coming to the hospital. Thank you!
Owner Name:
*
First Name
Last Name
Pet's Name:
*
Email
*
example@example.com
Cell Phone:
*
The phone you will have with you at the appointment.
What surgery is your pet having?
*
Spay or neuter
Dental (cleaning or cleaning with extractions)
Mass removal(s)
Cystotomy (stone removal)
Tooth trim (rabbit, rat, guinea pig)
Other
Please list any past surgeries your pet has had:
Is your pet showing any signs of illness?
Vomiting
Diarrhea
Coughing
Sneezing
Low appetite
Low energy
Drinking more
Urinating more
Other
During the surgery, your pet will be placed under anesthetic sedation to keep them comfortable. How has your pet handled being put under sedation in the past?
Handled it well
Had some issues
Never been under sedation
Not sure
Please list all medications and supplements your pet is on and when they were last given (please also include those not prescribed by Fredericton Animal Hospital):
What food does your pet typically eat?
Does your pet have any behavioural issues?
Biting
Timidness
Needing special handling
Other
Would you like any additional services while your pet is at the hospital? (additional charges may apply)
Placement of a microchip to identify your pet if missing
Updates to any due vaccines
Refills on any current prescriptons
Refills on parasite medication (Revolution, Nexgard)
Purchase food
Your pet's surgery will typically be completed by early afternoon. We will contact you with a post surgery update BETWEEN 11am and 2pm. How would you like to be contacted?
*
Phone Call
Text Message
Please bring to your appointment all medications your pet is currently taking.
Thank you!
Submit
Should be Empty: