Bannerman Pet Care

1580 Bannerman Road, Unit #5, Tallahassee, Fl 32312

Phone: (850)893-2043 Fax: (850)893-2012

Pre-Anesthetic Testing Consent Form

Please read carefully and sign.

Client:______________________________ Patient:________________ Age:______ Date:________

Your pet is scheduled for a procedure that requires anesthesia. We would like to take this opportunity to recommend pre-anesthetic testing and explain why it is important to the health of your pet. Like you, our greatest concern is the well-being of your pet. Before placing your pet under anesthesia, a veterinarian will perform a complete physical examination to identify any existing medical conditions that could complicate the procedure and compromise the health of your pet. Because there is always the possibility a physical exam alone will not identify all of your pet’s health problems, we strongly recommend a pre-anesthetic profile (a combination of tests) be performed prior to anesthesia. The tests we recommend are similar to, and equally as important as those your own physician would run if you were to undergo anesthesia. It is important to understand that a pre-anesthetic profile does not guarantee the absence of anesthetic complications. It may, however, greatly reduce the risk of complications as well as identify medical conditions that could require medical treatment in the future.

Signatures indicate your acceptance of the pre-surgical blood work and that anesthesia will be used on your pet during their procedure today. In addition, by signing this form, you are stating that your pet has been fasted prior to surgery.

Signature of Owner: ______________________________

Primary Telephone Number: ________________________

Secondary Telephone Number: ______________________

Please also complete the following while my pet is anesthetized (initial all items requested):

Home Again Microchip ID with Lifetime Registration _________

Dispense Flea Prevention ________