Diabetes 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): Lantus, Prozinc, Vetsulin.

Wellness testing recommended: DIABETIC MONITORING PROFILE. Other tests that may be requested are a BLOOD GLUCOSE CURVE and/or FRUCTOSAMINE LEVEL.

Recommended every 6 MONTHS

Risks associated with medication(s): hypoglycemia and seizures.

Discernable adverse effects: weakness, convulsions, ataxia and behavioral changes.

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.

Diabetes Waiver
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