Pre-Anesthesia Blood Screen Consent Form

“Because We Care”

 

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We recommend a pre-anesthesia blood chemistry panel on all pets prior to anesthesia. Most drugs are removed from the body by the liver and kidneys, therefore it is important that these organs are healthy. It is also important that patients have normal blood cell counts to promote proper tissue healing. The following tests are included in the pre-anesthesia blood panel:

1. CBC-Complete Blood Count-WBC, HGB, HCT, PLT
2. SGPT/ALT-Dectects liver damage
3. Total Protein-Liver function test
4. BUN-Kindney function test
5. Glucose-Blood sugar level to detect diabetes

The cost for this profile is $67.80

If any of these results are abnormal, we will discuss our findings with you and may decide to do one of the following:

1. Postpone the anesthesia procedure until a later date
2. Further testing to pursue a sepcific diagnosis
3. Proceed with anesthesia, but alter the drugs and procedures

If all tests are normal, it does not guarantee that your pet will not have an anesthesia reaction, but it does tell us that your pet is healthy and in a low risk category. If you have any questions regarding the blood panel or anesthesia please ask our staff and the doctor will be happy to answer them.

I would like to have the blood panel performed.

I DO NOT want to have the blood panel performed.

ANY ANESTHESIA CARRIES A SERIOUS RISK. THE MORE INFORMATION WE HAVE THE SAGER THAT RISK WILL BE.

The latest in office laboratory technology has enabled us to run blood chemistries within minutes, safely and accurately, before anesthetic procedures. As your veterinarian, I am happy to have this technology available to offer you, as well as safe anesthetic medications.

I have read the aforementioned information carefully and fully understand.

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Be sure you have also filled out our Anesthetic Consent Form.