New Client Form - Oak Heart Veterinary Hospital

Before placing your pet under anesthesia, we will perform a full physical examination. However, many conditions, including disorders of the liver and kidneys or blood, are not detected unless blood testing is performed. For senior pets, those over 7 years of age, we recommend a more comprehensive general panel. Such tests are important before any kind of surgery. For these reasons, we require, at a minimum, the pre-anesthetic panel prior to anesthesia unless, a pre-anethetic panel, general panel, or wellness panel has been performed within the last 30 days.

Pet's Name*

Please check the box that applies:*

Pre-anesthetic blood panel for pets less than 7 years of age
Comprehensive blood panel for pets 7 years of age and older

Please answer the following questions:

Did your pet eat today?*
Yes
No

If yes, please explain:

Did your pet urinate today?*
Yes
No

Did your pet defecate today?*
Yes
No

If yes, was it abnormal (i.e. diarrhea) please explain:

Has your pet had any unusual symptoms over the past two days: coughing/sneezing/vomiting?*
Yes
No

If yes, please explain:

Is your pet on a Heartworm preventative?*
Yes
No

Type of Prevention:

I hereby authorize the doctors at Eastern Shore Animal Hospital to perform the following procedures/surgeries on my pet.
Spay
Neuter
De-Claw
Dental
Microchip

Other authorized surgeries/procedures:

I certify the following:

1) I understand the procedure that is to be performed and its accompanied risks; and I authorize the use of appropriate anesthetics, medicines, and diagnostic tests deemed necessary by the doctors for the safe performance of the said procedure.

2) I understand that unforeseen complications or life threatening situations may occur during the above procedure; and I authorize the veterinarians and support personnel to alter procedure and to provide such treatments, in the doctors' professional judgement, as necessary to safeguard the life and health of my pet.

3) I understand that I will assume full responsibility for the care of my animal after it is released from the hospital, and that I should and will contact the hospital immediately if questions or complications develop during home care.

I have read and understand the Pre-Anesthetic Blood Test Information and Surgery Consent Form.

Email Address*
Email Address

Electronic Signature*
Electronic Signature

Date*
MM slash DD slash YYYY

Date

Telephone number where I can be reached today*
Telephone number where I can be reached today