University Animal Clinic

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)

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

Get Directions

HOURS

Day	Open	Closed
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

Call us today at 903-566-2212 to schedule your appointment.