Pre-Anesthetic Form

Before any procedure requiring anesthesia at the Animal Medical & Surgical Center of Coshocton, we ask that you complete our Pre-Anesthetic Form.

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Complete Your Pre-Anesthetic Form

Please complete and submit this form before your animal’s scheduled procedure. If you have questions about pre-anesthetic bloodwork or what to expect, call our team at (740) 622-0013.

Name *

First

Last

Phone *

Email *

Pet's Name *

At Animal Medical & Surgical Center of Coshocton, our greatest concern is the well-being of your pet. Your pet is scheduled for an anesthetic procedure. Before putting your pet under anesthesia, we routinely perform a full physical examination. In order to maximize patient safety, we highly recommend, and sometimes require, a pre-anesthetic blood profile. The surgeon may be alerted to the presence of certain conditions that could complicate the procedure, such as dehydration, anemia, infection, diabetes, and/or kidney or liver disease. These tests are similar to what your own physician would conduct prior to you undergoing anesthesia and help ensure the administration of the most appropriate anesthetic regimen. *

The Quantitative Blood Count (QBC) and Pre-Anesthetic Profile which includes: CBC (PCV (anemia), white blood cell count (infection) and red blood cell count (anemia/bleeding disorder), platelet count (clotting disorder)) and Chemistry Profile (BUN and creatinine (kidney), ALKP and ALT (liver), glucose (sugar), total protein (dehydration), and electrolytes (imbalance)).
The owner elects to decline the recommended pre-anesthetic blood tests at this time but requests that we proceed with the procedure.

Other tests are available that are not included...

Other tests are available that are not included in the above choices. The tests selected above give the doctor a suitable overview of healthy patients. For those patients who are sick or in their senior years (above the age of 9), a full senior profile can be performed the day of the procedure with the doctor’s recommendation or at the owner’s request.

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Pre-Anesthetic Form

Complete Your Pre-Anesthetic Form

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