(Fill out 1 form for each patient)
Phone Numbers (Please provide only numbers where you can be reached day of procedure)
Today your pet is scheduled to undergo a medical procedure requiring the administration of anesthetic
agents. We at Encanto Pet Clinic will perform this procedure with all reasonable care and precautions.
To better ensure your pet’s safety and ability to tolerate anesthesia, we require a pre-anesthetic blood
screening which does a complete blood count to check your pets blood clotting capability, assess adequate
oxygen carrying capacity, electrolytes, and assess proper liver and kidney function, which is how your pet
will metabolize the anesthetic after surgery. The fee for this pre-anesthetic blood screen is $82.80.
In addition, we also offer a pre-operative electrocardiac (ECG) evaluation. This service evaluates the
electrical conduction of the heart and looks for any arrhythmias.
Are there any other treatment or procedures you would like your pet to have today?
(services requested will incur additional fees)
I have read and understand the preceding information, and agree to the indicated procedures.
We are not a 24 hour clinic, therefore trained personnel are not on premises after business hours.
4340 E. Broadway Blvd.
Tucson AZ 85711