Name *

First Name

Last Name

Pets Name *

First Name

Last Name

I hereby authorise Kohimarama Veterinary Clinic to examine, prescribe for, treat or perform surgery on the above named pet. I also consent to the administration of anaesthetics as necessary, accepting the risks as explained below. During the course of treatment, products not licensed for animal use may need to be given. I understand that this is necessary, and give permission for these products to be used at the discretion of the veterinarian. 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. I confirm that the procedure/operation/treatment, together with possible risks and possible complications, as well as the expected outcome, has been explained to me, to my satisfaction. *

Yes

No

Do you give your consent today? *

Yes

No

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. 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 or cardiac arrest, and regurgitation of food with potential asphyxia. This is why we have asked your pet to not be fed 12 hours prior to surgery. Your animal will be closely monitored by trained veterinary staff using anaesthetic monitoring equipment. Consent to an anaesthetic being given to my pet today *

Yes

No

Not Relevent

Pain relief is an important part of every animals recovery from surgery. We dispense additional pain relief after routine surgeries to help reduce any post operative pain. *

I accept

I decline

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

Pills

Liquid

Either is OK

Have you been made aware that referral to a specialist may be an option for your pet? *

Yes

No

Kohimarama Vet Clinic recommends laser treatment at the end of surgery. The laser reduces pain and swelling associated with surgery and helps speed recovery. Please tick for laser therapy post-op $50.70 (If your pet is having a routine desexing procedure today this will automatically be included) *

Yes

No

Please tick if you require an estimate for this procedure *

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 any 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

Please indicate if any of the below are required *

Microchip implant $95.00

Nail clip $32.20

Clean/Pluck Ears $32.40

Remove Matt (varied)

I don't need any of these

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

If your dog is having a neuter or spey operation please make sure you have opened and read this link below. *

NOTE: PLEASE DOWNLOAD & READ THIS DOCUMENT HERE Once you have read the document above, please select an answer

I have read document and give consent for the procedure

I will phone to discuss further with vet 09 521 1457

Not relevant for my pet

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

Yes

No