Cardiac and Hypertension Waiver

I hereby decline the blood work my veterinarian has recommended every 6 months in order to maintain my animal on prescription medication. I understand the medication my animal is taking may have harmful side effects after prolonged use. I understand the blood work recommended would alert me to any of those harmful side effects before the medication did any permanent damage.

Medication(s): Amlodipine, Atenolol, Benazepril, Enalapril, Furosemide (Lasix), Spironolactone, Vetmedin.

Wellness testing recommended: MEDICATION MONITORING PROFILE – includes a chemistry profile, CBC (complete blood count) and urinalysis.

Recommended every 6 months

Risks associated with medication: renal dysfunction and elevated potassium levels. Atenolol can mask side effects associated with diabetes and hyperthyroidism. Lasix can induce fluid and electrolyte abnormalities (especially potassium, calcium, magnesium, and sodium).

* Vetmedin is a relatively new drug. Therefore, risks associated with long term use are not fully assessed.

Discernable adverse effects: anorexia, increased thirst and urination, vomiting, diarrhea, lethargy, depression, restlessness and weakness.

I am aware of the consequences by not performing this blood work. My veterinarian or representative has spoken with me at length about these risks and has answered al of my questions regarding my pet’s condition and the medication. I will make my veterinarian aware if any of these adverse effects occur and understand that blood work may need to be done at that time.

Cardiac and Hypertension Waiver
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