(361) 643-2112

Portland Veterinary Hospital

Request An Appointment 520 West Broadway Ave, Portland, TX 78374
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Pre Surgical Questionnaire

The questions below are extremely important to answer as correctly as possible. There is always a risk with anesthesia and surgery. Sometimes unforeseen complications do arise. We want your pet to have a good post- operative recovery without any secondary problems. To minimize the risk of complications, we start with a good history and physical exam.

Please check yes or no for each question:
Is your pet drinking water excessively?(Required)
Is your pet eating normally?(Required)
ls your pet sleeping more than usual?(Required)
ls your pet coughing, hacking or sneezing?(Required)
Does your pet have any gastrointestinal problems like vomiting, diarrhea or excessive gas in the last 2 weeks?(Required)
Have you noticed any skin problems in the last 2 weeks?(Required)
Have you seen any fleas or ticks in the last 4 weeks?(Required)
Have you seen any patches of bruising on the skin in the last 4 weeks?(Required)
Do you use rat poison?(Required)
ls your pet up to date on vaccines?(Required)
MM slash DD slash YYYY
ls your pet on any medication or supplements? (prescription or over the counter)(Required)
Does your pet have any hereditary problems?(Required)
ls your pet currently on heartworm prevention?(Required)
Have you noticed any episodes of lethargy, exercise intolerance, being tired or fainting?(Required)
ls your pet a brand new addition to the family?(Required)
Does your pet have any allergies?(Required)
MM slash DD slash YYYY
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(361) 643-2112 520 West Broadway Ave
Portland, TX 78374
Office Hours

Mon – Fri: 8-6
(Doctors are available 9-6)
Sat: 8-1
Sun: Closed

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    • Canine Neuter >101 lbs
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    • Surgery and Anesthesia Release: Canine Castration (0-25lbs)
    • Surgery and Anesthesia Release: Canine Castration (26-50lbs)
    • Surgery and Anesthesia Release: Canine Castration (51-65lbs)
    • Surgery and Anesthesia Release: Canine Castration 66-75lbs
    • Surgery and Anesthesia Release: Canine Castration 76-100lbs
    • Surgery and Anesthesia Release: Canine Spay 0-25lbs
    • Surgery and Anesthesia Release: Canine Spay 100+lbs
    • Surgery and Anesthesia Release: Canine Spay 26-50lbs
    • Surgery and Anesthesia Release: Canine Spay 51-65lbs
    • Surgery and Anesthesia Release: Canine Spay 66-75lbs
    • Surgery and Anesthesia Release: Canine Spay 76-100lbs
    • Surgery and Anesthesia Release: Ear Hematoma
    • Surgery and Anesthesia Release: Entropion
    • Surgery and Anesthesia Release: Feline Neuter
    • Surgery and Anesthesia Release: Feline Spay
    • Surgery and Anesthesia Release: Mass Removal
    • Surgery and Anesthesia Release: Rabbit Neuter
    • Surgery and Anesthesia Release: Rabbit Spay
    • Surgery and Anesthesia Release: Umbilical Hernia
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