Please read this form and bring it with you the morning of your pet’s appointment.

Your pet______is scheduled for______on_____/______/______.

Your pet’s check-in time is______AM

You are receiving this letter because your pet has been scheduled foran electivesurgical procedure at Thompson Veterinary Clinic. There are several important items to clarify prior to any procedure to make your check-in run smoothly and answer questions you may have.

Anesthesia: Your pet will require general anesthesia for the scheduled procedure. General anesthesia is usually a safe procedure; however, there can be unanticipated complications due to medical conditions or anesthetic drug sensitivities that can not be found on physical exam. To help minimize these risks, the following options are available:

  1. Pre- anesthetic labtestsare recommended for all patients, and are strongly encouraged for those 6 years and older and for those with documented pre-existing medical conditions. Laboratory tests screen for underlying diseases.These problems are uncommon in young animals and more of a concern in older patients. Cost for lab tests is $107.00.

I would like my pet to receive pre-anesthetic lab tests Yes No

* If your procedure is scheduled at the Munising Clinic please make sure to schedule any pre-anesthetic lab work prior to your pet’s surgery.

2. Intravenous (IV) catheter and fluids to help support blood pressure, and to facilitate emergency treatment if needed.

An additional fee of $82 will be charged for IV catheterization and fluids.

I would like my pet to receive IV fluids Yes No

Analgesia:All surgeries are painful procedures and pain can negatively affect your pets’ healing and recovery. Analgesics (pain relievers) will be administered at the time of surgery with additional pain relievers dispensed to be given orally at home. Cost ranges from $12 -$35 depending on the size of your pet.

Incision Care:Licking and chewing of the surgery site may lead to incisional problems, which may require additional fees to treat. We offer Elizabethan collars (E-collars) to help prevent this problem. Cost ranges from $9.00 - $24.50 depending oncollar size.

I would like an Elizabethan collar for my pet Yes No

Estrous Cycle and Pregnancy:If your pet is pregnant or in heat, thensurgery can still be performed. If your pet is known to be pregnant or in heat at the time of surgery, thenintravenous fluids will be recommended to maintain fluid volume during surgery. If your pet has been through a “heat cycle” in the last 4 weeks, then it is beneficial to wait an additional 2-4 weeks to have surgery performed. Please document last known heat: ______

Flea Control:For the protection of all our patients, if fleas are found on your pet then we will administer a pill (Capstar) that will kill all fleas on your pet. You will be charged approximately $7.50 depending on weight of pet. Your pet can still be re-infested with fleas when they get back home, so we will offer options for flea control when you pick your pet up.

Please REMEMBER TO REMOVE ALL FOOD AFTER 8:00 PM THE EVENING BEFORE SURGERY. Water is ok at any time. If your pet receives medication or has a chronic disease (i.e. Soloxine for hypothyroidism or anti-inflammatories for arthritis) then give your pet his or her medication as scheduled prior to surgery, but avoid giving them with food. Tell our staff all medications given the morning of surgery, as well as any medication that your pet has adverse reactions to. If your pet is diabetic, then please call our clinic prior to your procedure for special fasting and insulin instructions.

Medications: ______Time of last dose: ______

Additional requests (e.g. check ears/skin, update vaccinations, etc):______

By signing this form you are indicating you have been informed of the risks involved with anesthesia, and you have had an opportunity to discuss these risks with a veterinarian. Your signature further indicates you accept these risks and give the Thompson Vet Clinic permission to anesthetize your pet. Thompson Vet Clinic will utilize all reasonable precautions against injury, escape, or death of your pet.

Signature: ______

In the event there is a problem or a question regarding your pet, you must be available by phone during the day of your pets

procedure. Please list all phone numbers we can use to reach you. If we are unable to contact you, your pet’s procedure may have to be re-scheduled.

Phone :______( h) ______(w) ______(c)

Pick up times are the same day of the procedure between 3-4:30 p.m. (unless other arrangements have been made); declaw cats and kittens must stay overnight to be monitored.

Office hours are Monday-Friday 8a-5p and some Saturday's by appointment only from 9a-12 noon.

*If you are unable to keep your appointment, then please contact us at least 48 hours prior to your scheduled appointment.*

(906) 341-2813