Small Animal Pre-Surgical Screen Sheet

This pre-surgery check in is designed to help us screen for any concerns before your pet is brought into us for surgery. Please print out this sheet, fill it out, and bring it in with you to your appointment. Alternatively, you can scan this sheet and email it back to us at

History Questions (Answer for the past 14 days):

Additional Services at time of surgery

During this surgical procedure we will be placing your pet under general anesthesia. This state of unconsciousness is an unnatural state, and so carries risk. The risks for surgery include hypotension (low blood pressure), hypothermia or hyperthermia (high or low body temperature), hemorrhage (bleeding), infection, and allergic response to the anesthetic drugs used. More serious risks include cardiac events, stroke, and death. Anesthetic deaths are rare, and to limit the above risks, each patient undergoes a pre-anesthetic physical exam to ensure our patients are in good health, as well as a review of their medical history. Our patients are closely monitoring during surgery, measuring their vitals, blood pressure and other important parameters throughout the procedure. They also have intravenous fluids throughout the procedure for additional support.


Although there are risks for this elective procedure, the benefits include reduction of overpopulation, as well as:



Significant reduction in the risk of breast tumors.

Elimination of risks of infections of the uterus (pyometra), which can be life-threatening.

Eliminates risks of uterine & ovarian cancer.

Eliminates behavior associated with heat cycles.



Decreases risks of prostate enlargement and cancer.

Decreases behavior issues, such as roaming, spraying/marking, and fighting.

Eliminates risks of testicular cancer.

Please remember that your pet needs to be fasted before surgery. No food after 8PM the night before and NO breakfast the morning of surgery but water is allowed. If your pet has eaten before coming in, we may reschedule their surgery. Thank you so much for trusting us with the care of your pet! If you have any further questions or concerns, please do not hesitate to reach out.


Best Wishes,


From your team at Peace River Veterinary Service

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It can be done online by clicking the button below and completing our appointment request form.
You can also call us at 780-624-1606.