Pre-Surgical/Pre-Anesthesia Exam History

PRE-ANESTHESIA EVALUATION - Virtual Check-In

The following health history/risk assessment communicates valuable information to your pet's surgical team. It should take about 5-10 minutes to thoughtfully complete this form, and is best completed by your pet's primary caregiver.
Pet's Primary Adult Caregiver - Full Name

First NameLast Name
Pet's Other Adult Caregiver(s) if Any
Name(s)
Valid Caregiver E-mail
Preferred Phone Number Confirmation

Area CodePhone Number
When Patient is In Recovery How Would You Like to Be Contacted?

Other
Pet Patient's Name
Date of Scheduled Procedure

MonthDayYear
Date
If different than the caregiver(s) listed above, who is the adult person presenting this pet patient to Highland during the appointment/check in time?

First NameLast Name
Goals for today's procedure
List your understanding of the purpose of this anesthetic procedure or visit, and/or any questions you have about the procedure.

Oncology Screen
Oncology Screen II
Your response has indicated the need to have a first time look, or fresh look at new growth or a previously diagnosed benign tumor in or under your pet's skin. Please indicate how long the growth may have been present, or what changes you've noticed in any old growths you would like examined.
Oncology Screen III

Browse Files
If you have a photo of a lesion, or lump or bump or the location on the body that you would like to upload to your pet's chart, please feel free to do so. Cancelof

PRE-ANESTHESIA EVALUATION - Virtual Check-In