Sedation Form Name* First Last Pet's Name* First My pet is a:*DogCatLarge/Farm AnimalOtherAre you submitting this form for multiple pets?*YesNoPlease list all pet names, separated with a comma, that this form is for*Phone number we can reach you at today*Is your pet on Heartworm preventative?*YesNoCan we run a Heartworm test today?*YesNoIs your pet pregnant?*YesNoNot ApplicableDoes your pet have seizures?*YesNoWhat procedure is being performed?*Spay/NeuterDentalLarge/Farm Animal ProcedureOtherDepending on your selection we may have more questions for you over the phone. Would you like your cat declawed?*YesNoNot applicableWe declaw front paws only.Would you like Pre-Anesthetic Blood Testing?*Yes, I want Pre-Anesthetic Blood Testing and agree to the additional charge.NoI would like more information.Your pet will be undergoing general anesthesia plus a surgical procedure today. In order to help recognize underlying abnormalities your pet may have, we recommend having a pre-surgical blood profile run on your animal. This consists of a COMPLETE BLOOD COUNT, ALT, TP, and BUN. These blood tests will help us to assess the health status of your pet more completely and aid in determining if there are any additional precautions we need to take before surgery. We highly recommend a blood profile for geriatric animals (animals older then 7 years). There is an additional charge for these blood tests. We hope you understand the need for these important tests.Would you like your pet microchipped?*Yes, I want the microchip and agree to the additional chargeNoA microchip is a form of permanent identification that will remain with the pet for the rest of its life The microchip is injected under the skin between the shoulder blades. This procedure can be done at any time but it is easier to do it while your pet is under anesthesia. If this procedure is done while your pet is under, it is done at a discounted rate.Would you like your pet to receive Oravet?*Yes, I want Oravet and I approve the additional chargesNoOravet is a plaque-prevention system for your pet. After your pets dental your veterinarian will apply a barrier sealant to help plaque and tartar forming bacteria from coating the teeth. One week after your pets dental, you will begin the daily. orate chew to help slow tartar build-up. A two week supply will be sent home at an additional charge.Flea/Tick Treatment Pre-Surgery* I understand that if my pet has fleas or ticks that Caldwell Veterinary Clinic, PLLC has permission to treat my pet at my expense.We typically use Capstar for pre-surgical treatment to aid in keeping surgery sterile. Capstar's are given based off weight. Authorizing Anesthesia* I am the owner or responsible party for above animal and am authorizing the anesthesia agreement below.I have been informed that examinations under anesthesia often reveal abnormally loose teeth that fall out or should be extracted to prevent oral discomfort and ongoing infection of surrounding bone. Although very rare, cleaning or removing diseased teeth could weaken the jaw and cause fracture. I also have been informed that the loss or removal of one or more unhealthy canine teeth occasionally allows for an awkward protrusion of the tongue to one side or the other. Nevertheless, all questions and concerns I have about the recommended dental procedures have been answered to my satisfaction. I hereby certify that I am the owner of the above animal or am responsible for the above animal, and have the authority to execute this consent. I hereby also authorize the use of such anesthetics as you deem advisable and performance of such surgical or therapeutic procedures as you determine to be indicated. I agree to indemnify and hold Caldwell Veterinary Clinic, PLLC harmless from and against any and all liability arising out of the performance of any of the procedures referred to above.Authorizing Anesthesia* I am the owner or responsible party for above animal and am authorizing the anesthesia agreement below.I hereby certify that I am the owner or am responsible for the above mentioned pet and have the authority to execute this consent. I hereby also authorize the use of such anesthetics as you deem advisable and performance of such surgical or therapeutic procedures as you determine to be indicated. I understand that my pet will be identified with a permanent tattoo showing that they have been surgically altered. I agree to indemnify and hold Caldwell Veterinary Clinic, PLLC harmless from and against any and all liability arising out of the performance of any of the procedures referred to above. Authorizing Anesthesia* I am the owner or responsible party for above animal and am authorizing the anesthesia agreement below.I understand that the procedure to be performed on my animal requires sedation and anesthesia. I understand that in this procedure, whenever sedation and anesthesia are used, there is some risk to the animal. I further understand that the Caldwell Veterinary Clinic and the Doctors are not responsible for sedation or anesthetic losses during induction, surgery, or the recovery phase of this procedure.