Pre-Anesthetic Survey Form

Prior to any surgery or procedure requiring anesthesia, we ask that you complete our Pre-Anesthetic Survey Form. This short questionnaire provides important health details that help us create a safe, personalized anesthesia plan for your pet.

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Complete the Pre-Anesthetic Survey

The form covers your pet’s recent health history, medications, lifestyle, and any previous anesthesia experiences. Your answers help us reduce risks, tailor monitoring protocols, and provide the best care possible.

If you have any questions while filling it out, please call (207) 499-4295, and we’ll be happy to assist.

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At Southern Maine Veterinary Care, 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.

Other tests are available that are not included in the above choices. The tests selected above give the doctor a suitable overview of healthy patients. For those patients who are sick or in their senior years (above the age of 9), a full senior profile can be performed the day of the procedure with the doctor’s recommendation or at the owner’s request.

Our ability to minimize anesthetic and surgical risks and maximize patient safety is greatly enhanced by the completion of a physical examination and blood work prior to a surgical procedure. If you have any questions or concerns about the scheduled procedure, please do not hesitate to call or email at (207) 499-7244 / info@smvetcare.com to discuss any aspect of the upcoming procedure.

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Pre-Anesthetic Survey Form

Complete the Pre-Anesthetic Survey

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