773-631-5300 contactus@chicagocatclinic.com

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Chicago Cat Clinic

Pre Surgery & Anesthesia Information Form

Save time during your next appointment! Complete your pre-surgery & anesthesia information form online from any device at any time before your visit.

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Online Forms

Pre Surgery & Anesthesia Information Form

Client's Name *

First

Last

Client's Email *

Date *

Patient's Name *

Patient's Number

Client

In the last week has there been any

Vomiting ?
Diarrhea ?
Coughing ?
Sneezing ?
Changes in water consumption ?
Changes in urination ?
Changes in appetite ?
Changes in activity ?

If yes to any of the above, please explain

If you have any questions or concerns the doctor should be aware of, please explain?

If your cat had any previous problems with any of the following, please explain

Anesthesia ?
Pain Medications ?
Antibiotics ?
Other Medications ?

Please Explain

Please list any medications your cat is receiving and what when last given: *

Office Use Only

Vaccines: Date last given

PCR

Rabies

Felv

Preanesthesia labs approved by DVM?

Other labs recommended today?

I HAVE READ AND FULLY UNDERSTAND THIS SURGERY AND ANESTHESIA CONSENT FORM *

Yes

Comment

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We’re Dedicated To Your Cats

We are proud to provide your cat with the highest quality veterinary services and offer a calm, quiet, canine-free environment. We proudly serve the cats of Edgebrook, Jefferson Park, Forest Glen, Niles, Lincolnwood, Edison Park, Morton Grove, Skokie, Harwood Heights, and surrounding communities. Easily request an appointment for your pet using our online system on PetDesk. Keep up with your pet’s health by downloading our app!

Appointment Download App

Have a question?

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Address

5301 W Devon Ave, Chicago, IL 60646

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Contact

Email: contactus@chicagocatclinic.com
Phone: 773-631-5300

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Hours

Mon – Fri: 8am – 6pm
Sat: 8am – 2pm
Sun: Closed

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