Surgery/Dental Check In Form

Name

First NameLast Name

Pet Name

What procedure is your pet scheduled for?

Is your pet currently on any medications (including homeopathic or supplements)?

Please withhold food from your pet from 8pm starting the night before the procedure. It is ok to offer water until the morning of procedure.

PreAnesthetic bloodwork is strongly recommended prior to any anesthetic procedure to ensure that your pet is in a low-risk category prior to anesthesia. The results of these tests also serve as a baseline reference value should your pet become ill in the future.

If your pet is middle-aged (5 years) or older, current bloodwork is required before any anesthetic procedure. (If it has been longer than 6 months since your pet’s last blood panel, the doctor may require it).

If your dog weighs 25 pounds or less, bloodwork is required before any anesthetic procedure.

If your pet weighs 26 pounds or more, and is 0-4 years old, would you like us to run preanesthetic bloodwork on your pet today? The cost is $96.00.

All dogs must have a current heartworm test.

All cats must have a negative FIV/FeLV/HWT on file.

All Growth Removal Surgeries: If all growths or lumps to be removed are not obvious, please shave the fur or mark all growth locations with nail polish or a permanent marker.

All Growth Removal Surgeries: If the doctor recommends a histopathology of tissue from the growth (the presence or absence of abnormal cells), Westosha Veterinary Hospital has permission to send the sample to the lab for pathologist review. We usually have results within 1 week.

Permission for pathologist review

K-laser treatment. We offer post-surgical or post-dental laser therapy treatment. This is the use of wavelengths of light (red and near-infrared) to create therapeutic effects. These effects include improved healing time, pain reduction, increased circulation, and decreased swelling.

Would you like us to perform laser therapy on your pet today for pain and inflammation after his/her procedure?

Your pet’s vital signs (heart rate, blood pressure, respiratory rate, oxygen status, ventilation and temperature) are monitored continuously throughout the procedure. There is still always a risk when undergoing anesthesia.Should unexpected life-saving emergency care be required and the hospital staff is unable to reach me, the staff has my permission to perform CPR and I agree to pay for such services.

Do you need a refill of flea and tick and/or heartworm preventative?

If your pet is not already microchipped, we can place one today while your pet is under anesthesia. We use Home Again microchips and register your pet for life.Would you like us to microchip your pet today?

Pets undergoing surgery or dental procedures usually go home after 3pm. Do you have a preferred pick-up time today?

Best phone number for us to reach you when your pet is in recovery:

Please enter a valid phone number.

Please verify that you are human*

Surgery/Dental Check-In Form