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Swann Animal Clinic

pre-anesthetic Form

Please fill out our pre-anesthetic form prior to your pet’s surgery with us.

pre-anesthetic FORM

Please fill out this form as completely as possible so we can get to know you and your pet(s) before your visit. Thank you!

What To expect meet the team

Pre-Anesthetic Form

"*" indicates required fields

Name*

First Last

Phone*

Email*

Pet's Name*

At Swann Animal Clinic, our greatest concern is the well-being of your pet. Your pet is scheduled for an anesthetic procedure. Before putting your pet under anesthesia, we routinely perform a full physical examination. In order to maximize patient safety, we highly recommend, and sometimes require, a pre-anesthetic blood profile. The surgeon may be alerted to the presence of certain conditions that could complicate the procedure, such as dehydration, anemia, infection, diabetes, and/or kidney or liver disease. These tests are similar to what your own physician would conduct prior to you undergoing anesthesia and help ensure the administration of the most appropriate anesthetic regime.*

The Quantitative Blood Count (QBC) and Pre-Anesthetic Profile which includes: CBC (PCV (anemia), white blood cell count (infection) and red blood cell count (anemia/bleeding disorder), platelet count (clotting disorder)) and Chemistry Profile (BUN and creatinine (kidney), ALKP and ALT (liver), glucose (sugar), total protein (dehydration), and electrolytes (imbalance)).

The owner elects to decline the recommended pre-anesthetic blood tests at this time but requests that we proceed with the procedure.

Procedure location*

SAC at 45th

SAC at Hillside

SAC at Plum Creek

Surgical Procedure

Spay/ Neuter

Dental

Mass Removal

Orthopedic

Other

Please specify:

Procedure Date*

MM slash DD slash YYYY

A physical exam alone does not allow us to know how your pet's organs are functioning. This simple test prior to anesthesia and surgery gives us a quick look at complete blood count and organ function. By knowing these values, we are better able to identify potential complications and reduce anesthetic risk. Pre-anesthetic blood work is recommended for all animals but is required for all animals over the age of 4 years.

Previously completed (in-clinic or reference lab within 90 days)

Basic ($118.05): Ideal for pets less than 8 yrs old & less complicated procedures

Premium ($160.35): Preferred for older pets & more complicated procedures

Decline - This increases anesthetic risk.

It is well known that our pets experience pain when they have surgery. We also know that our pets recover more quickly from surgery if their pain is well managed. Some pets also benefit from oral pain medication administered at home for extended pain management.

Accept ($35-$60): Includes a pre-operative injection and 3-5 days of oral pain medication. Cost varies on your pet's breed, weight, procedure, and current health condition.

Decline - For surgery and some dental procedures, pain management will be required.

Additional Procedures: Please check all procedures you would like performed on your pet today. These items will be added to the cost of your original estimate.*

None

Nail trim

Anal Glands

Flea/tick prevention

Heartworm prevention

Other

If other, please explain

Every anesthetic procedure involves some element of risk. In the unlikely event of cardiac arrest, we need to understand what lifesaving measures we should undertake. Please select you wishes for your pet below*

Perform CPR (additional charges will apply)

Do not resuscitate (no lifesaving measures will be taken)

Please confirm the selected option above*

Perform CPR (additional charges will apply)

Do not resuscitate (no lifesaving measures will be taken)

By marking "Accept" below, you are certifying that you have read and fully understand this authorize for treatment. You are also stating that you are the owner or agent for the described animal and have authority to execute this consent. As the client, you assume financial responsibility for all charges incurred to the listed patient and agree to pay all charges when the animal is released from the hospital. You also understand that any procedure, especially anesthesia, involves some risk and the results cannot be guaranteed. If the animal is not current on the required vaccinations as listed, this will be done upon hospitalization and added to the cost of the listed procedures. Electrosurgery may be used during your pet's procedure. This modality allows us to minimize bleeding through cauterization of small blood vessels. If you pet has an internal pacemaker or defibrillator, please inform your veterinarian.*

I accept

I do not accept

Signature*

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Email

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Caring for the pets of Amarillo, TX.

We are a full-service veterinary hospital dedicated to providing the best possible care for your cat or dog. We offer extended hours and an urgent care clinic for after-hours emergencies with twelve veterinarians between our three locations. We look forward to exceeding your expectations!

Book Appointment

Have a question?

Please allow up to one business day for our staff to respond to your request. If you have an emergency, please call our clinic to schedule an appointment or schedule an appointment online.

Experiencing an emergency?

We now offer urgent and emergency care at our clinic on 45th Avenue Mon–Fri: 7 am to 8:30 pm and Sat: 8 am to 5 pm! Call us immediately at 806-355-9445. Our team will be ready for you the moment you arrive. Learn more here.

SAC AT 45TH
SAC AT HILLSIDE
SAC AT PLUM CREEK
URGENT CARE
SIDEKICKS

Address:
3102 SW 45th Ave.
STE 100
Amarillo, TX 79109

Contact:
806-355-9443

Hours:
Mon–Fri: 7 am to 8:30 pm
Sat: 8 am to 5 pm
Sun: Closed

Urgent Care is available Monday–Friday 7 am to 8:30 pm and Saturdays 8 am to 5 pm.

Address:
6204 Hillside Rd.
STE 1000
Amarillo, TX 79109

Contact:
806-803-9105

Hours:
Mon–Fri: 7 am to 6 pm
Sat: Closed
Sun: Closed

Address:
8723 Plum Creek Dr.
Amarillo, TX 79124

Contact:
806-355-9444

Hours:
Mon–Fri: 7 am to 6 pm
Sat: Closed
Sun: Closed

Looking for Sidekicks Stay & Play?

Address:
3102 SW 45th Ave.
STE 150
Amarillo, TX 79109

Contact:
806-355-9445

Hours:
Mon–Fri: 7 am to 8:30 pm
Sat: 8 am to 5 pm
Sun: Closed

Address:
8723 Plum Creek Dr.
Amarillo, TX 79124

Contact:
806-395-3133

Hours:
Mon–Fri: 6 am to 8 pm
Sat: 7 am to 7 pm
Sun: 7 am to 7 pm

Check-in: 6 am to 10 am
Check-out: 4 pm to 7:30 pm

Contact Form

"*" indicates required fields

Name*

First Last

Email*

Phone

Preferred Location

Preferred Doctor

Preferred Doctor

Preferred Doctor

Preferred Doctor

How can we help you?*

Disclaimer: All responses are generally returned in 1-2 business days. If this is an urgent pet concern, please call us at 806-355-9445. If you would like to schedule an appointment, please schedule here.

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