Name *

First Name

Last Name

Modern anaesthetics are very safe but there is always an element of risk which increases with age. Pre-existing medical conditions can also increase the level of risk. Pre-anaesthetic blood tests can help detect these conditions. We advise blood tests for animals over 7 years old. Please discuss this option with us. If your pet has been off colour lately or you have any information which you feel may influence our choice of anaesthetics please tell us on admittance. Potential anaesthetic risks include respiratory arrest, cardiac dysfunction and regurgitation of food with potential asphyxia. This is why we have asked for your pet not to be fed 12 hours prior to surgery. However animals under anaesthesia are monitored using respiratory detectors and/or pulse oximetry. *

I consent to the administration of anaesthesia as necessary, accepting the risks as explained. Furthermore, I agree to pay fees for services rendered at the time the pet is discharged from the clinic or when service is otherwise terminated.

Yes

No

I consent to the extraction of any teeth that the veterinary surgeon considers may cause further health problems for my pet *

Yes

No

If medication is required post surgery, which of the following is the easier for you to give? *

Pills

Liquid

Either is OK

Is your pet on a raw food diet *

Yes

No

Is my pet vaccinated? *

Yes

No

I understand that if my cat/dog is going under a General Anaesthetic today he/she must not have food after 10pm the night before (if you have a rabbit please phone us for instructions) *

I agree

I disagree

Not relevant for my pet

Like you, our greatest concern is the well-being of your pet. Before putting your pet under anaesthesia, we will perform a full physical examination. However, many conditions, including disorders of the liver, kidneys or blood, are not detected unless blood testing is performed. Such tests are especially important before any kind of surgery. For these reasons, we highly recommend blood screening before such procedures. The total cost of the pre-anaesthetic blood screen is $213.50 for pets under 8 years of age. For pets over the age of 8 years we include two additional tests SDMA+T4 to test kidney function and thyroid function. The total cost for the pre surgical blood test and SDMA+T4 is $294.50 Cats over 10 years old are more likely to have an over active thyroid gland which can elevate liver enzymes and cause heart problems. Our laboratory is fully equipped and staffed to perform these important blood tests. Results will be immediately available to examine before anaesthesia and/or surgery. If a pre-anaesthetic blood test has recently been done, please also indicate this in the appropriate box. Please indicate your choice below: *

Would you like your pet to have a pre-anaesthetic blood test

YES, I want my pet to have the pre-anaesthesia blood screen for pets UNDER 8 years $213.50

YES, I want my pet to have the pre-anaesthesia blood screen for pets OVER 8 years $294.50

NO, I do not want my pet to have a pre-anaesthesia blood screen

My pet has ALREADY had this done, within the last 3 months

I will discuss with the veterinarian

I consent to my pet's hospitalization/procedure today (ticking yes will be used instead of a signature) *

Yes

No