University Animal Care Clinic

2711 University Blvd
Tyler, TX 75701

(903)566-2212

www.universityanimalclinictyler.com

Anesthesia and Surgery Form Form

Appointment :
Name (required)
First Name (required)
Last Name (required)
Pet Name:
1. Surgery / Procedures:
Anesthesia/Sedation
Spay/Neuter
Declaw 2 front feet
Growth/Lump Removal
Radiograph
Blood Sampling
TNT
Other
If OTHER:

2. Diagnostic Tests:
Tests are important to detect early stages of disease, monitor response to treatments and access side effects and levels of chronically administrered meds.
Mark what you want for your Pet:
Heartworm Test Dogs ($52.74)
Fiv-Leukemia Test for Cats ($82.31)
Basic Organ Screen recommended for <5 years age ($68.83)
Comprehensive Blood Work recommended >5 Years age ($204.65)
I decline ALL recommended Tests
3. Pain Management:
We use injectable pain medicine for all surgery procedures. If you would like your pet to have a prescription of pain medicine to follow up with at home ($19 - $40)
Accept
Decline
4. Exam and Vaccinations: (Must be current for health and liability purposes)
Dogs:
Exam
Rabies
Distemper Series
Bordatella
Cats:
Exam
Rabies
FCPR
Leukemia
5. Consent:
I authorize University Animal Care Clinic to preform the above procedures. i understand there is always a risk from anesthesia and surgery. We will take all precautions against unforeseen problems and will not be held liable within that capacity.
Signature:


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University Animal Clinic
2711 University Blvd
Tyler, TX 75701  US

Phone : (903)566-2212
 Fax : (903)566-2288

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HOURS


Day Open Close
Monday 7:30am 5:30pm
Tuesday 7:30am 5:30pm
Wednesday 7:30am 5:30pm
Thursday 7:30am 5:30pm
Friday 7:30am 5:30pm
Saturday Closed Closed
Sunday Closed Closed

 Free Exam for first time clients, including vaccination exam!! Be sure to mention this ad to receive your discount!! Call us today at 903-566-2212 to schedule your appointment.