Contact us Contact for practicing veterinarians Questionnaire Requested consult: Sedation General anesthesia Troubleshooting Pain management Purpose of sedation/Anesthesia: Patient information Species Breed (list as unknown if not determined) Age Weight (kg) Demeaner TPR Blood work/Date (attach the results to a separate email)(put NONE if no blood work results) Imaging (If yes, results?)(Put NONE if no imaging) Hx of previous anesthesia/complications (If yes, describe) Concurrent diseases (if any) Current medications Facility related information Anesthetic-related medications available at your practice: Anesthetic equipment available at your practice: Anesthesia machine with Sevoflurane Anesthesia machine with Isoflurane Anesthetic monitoring modalities ECG Pulse oximeter Capnograph Blood pressure Fluid pump Syringe pump Other Practice Information Name of the practice Name of the veterinarian/veterinary nurse requesting the service Address Phone number Email address Date Terms/Consent The consultee or their representative consents and accepts the following terms: The consultation service and information provided by the expert is tailored to the needs of the intended individual animal and should not be applied to any other animal or condition. To pay all consultation-related charges Accept all liabilities related to the final outcome of the procedures performed Accept Submit Contact for pet owners To consult with us for anesthetic and analgesic needs of your pet, contact us using this form or email us at Email: [email protected] Submit