Monday – Friday
8:00 am – 5:30 pm
Saturday Closed
Sunday Closed

4340 E. Broadway Blvd.
Tucson, AZ 85711

Anesthetic Consent Form

Anesthetic Consent Form


    (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.

  • MM slash DD slash YYYY
  • We are not a 24 hour clinic, therefore trained personnel are not on premises after business hours.

  • This field is for validation purposes and should be left unchanged.