Pre-Anesthetic Blood Work Form Pet Name* Owner Name* Babcock Hills Veterinary Hospital uses state-of-the-art equipment to perform pre-anesthetic blood profiles. We are committed to the value of these tests and to making this technology available for our clients and their pets. PLEASE READ AND ACKNOWLEDGE BELOW. ALSO, YOUR DIGITAL SIGNATURE AND DATE ARE REQUIRED AT THE END OF THIS FORM. Your pet is scheduled for an anesthetic procedure at Babcock Hills Veterinary Hospital. Pre-anesthetic blood work is necessary to help doctors detect the presence of any possible underlying disease(s) that may impact the decision to proceed or may alter the medical protocols chosen by the doctor. The result of these tests will also serve as a reference baseline for comparison in the future should your pet’s health change.Acknowledgement of needs for pre-anesthetic blood work statement.* YES - I understand Patients UNDER 7 years of age- Cost $116. Includes:CBC (complete blood count) to assess anemia, infection, blood clotting and some cancers; BUN (kidney, hydration, liver, G.I. bleeding); ALT (liver); Creatnine (kidneys); T.P.(hydration); Glucose (blood sugar); ALKP (liver); Sodium, Potassium and Chloride (hydration, kidneys, liver, adrenal glands,acid/bases balance) Patients OVER 7 years of age- Cost $174. Includes:CBC (complete blood count) to assess anemia, infection, blood clotting and some cancers; BUN (kidney, hydration, liver, G.I. bleeding); ALT (liver); Creatnine (kidneys); T.P. (hydration); Glucose (blood sugar); Albumin (kidneys, liver, gut, dehydration, etc.); Globulin (Immune status, infection, allergies); Calcium (some cancers, some poisons, adrenal glands, kidneys, parathyroid glands); Cholesterol (thyroid, liver, kidney); Phosphorus(kidneys, parathyroids, gut); Bilirubin (liver, red blood cells); Amylase (pancreas, kidneys); ALKP (liver); Sodium, Potassium and Chloride (hydration, kidneys, liver, adrenal glands, acid/bases balance); Urinalysis (dipstick / specific gravity).I have read and understand this authorization and consent. Please type your Digital Signature:* Date* MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged.
