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Our Hospital
Meet the Team
Hospital Tour
Careers
Forms & Policies
AAHA-Accredited Hospital
Services
Senior Wellness
Vaccinations
In-House Laboratory
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Microchipping
View All Services
New Clients
Payment Options
Shop Online
Contact Us
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Blood Glucose Curve Consent Form
Blood Glucose Curve Consent Form
Client Name
Date
MM slash DD slash YYYY
Pet Name
Primary Contact Phone Number
Alternative Contact Phone Number
Your pet is being admitted to the hospital today for blood glucose monitoring. A glucose curve is performed by taking a small sample of blood multiple times throughout the day to check blood glucose levels. Please provide the following information; it will greatly assist veterinary staff in providing your pet with proper treatment.
Did your pet eat this morning? How much and at what time?
Did your pet receive insulin this morning? What time?
What is the current dosing of insulin your pet is on (units)?
Have you noticed your pet drinking more frequently?
Yes
No
Have you noticed your pet urinating more frequently?
Yes
No
Have you noticed any attitude or behavioral changes in your pet?
I, the undersigned owner or agent of the owner, certify that I am eighteen years of age or over and authorize the veterinarian(s) at this practice to perform the above procedure(s). I understand that I am encouraged to discuss any concerns or questions about any medical risks with the doctor before any exam/procedure is/are initiated. I understand that medical treatments, including anesthesia, are not without risks. Your signature below signifies understanding of the above and authorizes the attending veterinarian to perform the procedures listed as well as any emergency treatment that may become necessary. Your signature also releases Bensenville Animal Hospital of any liability associated with the treatment of your pet both during and after service rendered.
Client Signature
Date
MM slash DD slash YYYY
Client Printed Name
Hospital Employee Initials
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