Procedure Information

Your Name*

First Last

Email*

Phone*

Pet Name*

Date of Procedure

Type of Procedure*

Dental
Spay
Neuter
Other Anesthetic Procedure

History Over Last 48 Hours

How is your pet doing generally?

Do you have any particular concerns?

Check any that apply:

Does your pet have normal appetite and energy?

When was your pet’s last meal?

List any current medications or supplements that your pet is on. Include doses, frequency, and how administered.

Significant Medical History

List any chronic medical conditions that your pet has:

Do you have any questions or concerns about general anesthesia?

Does your pet have a history of seizure activity or anesthetic complications?

Do you have any requests in addition to the procedure (vaccines, mass removal, biopsy, ear cleaning, nail trim, etc.)?

Contact Information

Do you have time constraints on the day of the procedure?

What is the best number at which to reach you during the procedure?

REMEMBER TO PLEASE STAY CLOSE TO YOUR PHONE DURING THE PROCEDURE IN CASE THE VET NEEDS TO CONTACT YOU

Do you have the Pet Kare Clinic smartphone App?

Yes
No

Reminder

** Please remember to fast your pet overnight, no food after 10pm the night before surgery or the morning of surgery, water is fine **

Surgery/Dental Checkin Questionnaire