BRADEN RUN ANIMAL HOSPITAL
Dr. McMillen and her staff at Braden Run Animal Hospital would like to thank you for allowing us the pleasure of taking care of your pet during his/her surgical stay. We pride ourselves in providing the best care possible for your pet and hope to continue to provide our services throughout their lifetime.
To serve you better, you may fill in this form prior to your pet’s admission for his/her procedure. You may do any of the following:
Print out the form, fill it out and bring it with you.
Fill out the form when you bring your pet in for his/her procedure.
OR
Follow these seven (7) easy steps:
Thank You
Surgery Admission Form & Anesthesia Form
Your Full Nameis scheduled for surgery on (surgery date)
Check in time is scheduled for 8:15am. Do not allow any access to food after 8:00 PM. Your pet may have water until midnight; please inform the doctor or staff if food or water was consumed after these times. You will be instructed to call our office after 1:00pm to obtain a discharge time. Discharge times are usually between the hours of 2:00pm – 4:00pm. If for any reason you are unable to pick your pet up before 5:00pm, you will be charged a $23.00 boarding fee for any overnight stay.
Included you will find a pre-anesthetic blood testing consent form and a surgery admission form for your pet’s procedure. Please read over carefully and sign and date all forms prior to your arrival. If you have any questions, please feel free to call our office or speak with the admitting Technician on the morning of surgery. Please answer the following questions and bring this form, along with the enclosed forms with you on surgery morning.
PATIENT INFORMATION
Does your pet have any allergies that you are aware of? Please type Yes or No in the text box area
If yes, please describe
Does your pet have any history of seizures? Please type Yes or No in the text box area
List ALL medications your pet is currently taking
Is your pet’s vaccination status current? Please type Yes or No in the text box area
If no, would you like for us to vaccinate today? Please type Yes or No in the text box area
We offer the following services while your pet is here for his/her procedure. Please check any that you would like to have done today.
Please type Yes or No in the text box area
Nail Trim ($11.00)
Microchip ($43.00)
Feline Leukemia Test (for cats) ($45.50)
Heartworm Test ($28.00)
Anal gland expression ($13.00)
The most common complication during surgery is associated with anesthesia. Complications due to anesthesia can result in death. All animals receive pre-op pain medication, EKG/pulse oximety monitoring, and an IV Catheter placement. Each animal will be examined by a veterinarian pre-operatively, and special recommendations may be made to further reduce this risk.
ALL animals going under anesthesia should have bloodwork performed pre-operatively. The basic panel is a CBC and a Chemistry Screen. For patients over five years of age, a more in-depth chemistry panel [General Health Profile] will need be done, along with the CBC. Dogs that have not been tested for heartworm should be tested at this time. Cats that have not been tested for feline leukemia and the feline immunodeficiency virus should be tested as well.
As owner, or duly authorized agent of the owner of the above named animal, I hereby consent and authorize the hospital to receive, prescribe, treat or operate on this animal.
Electronic Signature of Owner or Owner's Agent. Sign & Date here at hospital ______________________________________
Please read carefully, fill in the appropriate boxes / fields below and sign.
Anesthesia Form
Client: Patient: Age: Date:
Like you, our greatest concern is the well-being of your pet. Your pet is scheduled for anesthesia prior to his/her procedure. Before putting your pet under anesthesia, we will perform a full physical examination. A pre-anesthetic blood profile should be performed to maximize patient safety and alert the veterinarian to the presence of dehydration, anemia, infection, diabetes, and/or kidney or liver disease which could complicate the procedure. It is unlikely that these conditions will be detected without a pre-anesthetic profile. These tests are similar to those your own physician would run if you were to undergo anesthesia. In addition, the results of these tests may be useful, if your pet's health changes, to develop more accurate diagnoses and treatments.
State of the art equipment enables us to perform the pre-anesthetic blood profile at our hospital and we are committed to making this technology available to your pet.
It is in the best interest of your pet's safety and wellbeing that the following laboratory work be performed prior to surgery.
The Cost of the CBC [Includes: Hematology Complete Blood Count] $30.00
The cost of the Pre-Anesthetic Profile [ Blood Chemistry Screen] is $32.00
The cost of a General Health Profile (for dogs and cats over five years of age) is $47.00
See our pamphlet for descriptions.
Type "YES" in the text box if you wish to have the CBC & Pre-Anesthetic Lab-work done prior to the procedure
Please sign electronically. You will also be required to sign in person at our hospital.
Complete the bloodwork prior to the surgical procedure on my pet. __________________________________
If abnormalities are found please contact me at this telephone number: __________________________________
Email Link: frontstation@windstream.net
___________________________________________________________________________________________________________________
OR
I have elected to REFUSE the recommended pre-anesthetic blood tests at this time and I request that you proceed with the anesthesia and procedure. I assume FULL financial responsibility for this animal regardless of the outcome. I understand there are always potential risks, even death, when using anesthesia or performing surgery on an animal.
Electronic Signature: Date: