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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