Welcome to The Village Vet

Please complete the following details.

Company

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Desexing Surgery Consent Form

Which Clinic are your visiting?

Pymble

Killara

Patient & Customer Details

Patient Name

Patient Weight Today

Customer Name

First Last

Address

Phone(Required)

This number should be able to be contacted during your pet’s entire stay with us. If you require another person to make decisions on your behalf if you can’t be contacted, please add their number to the next box.

Alternate Contact No. if different for today:

Insurance

Do you have Pet Insurance?(Required)

Yes

If you wish to claim for today please let our team know and we can submit it electronically for you.

Would you like us to make GAP claim for you?

Yes

Insurance Provider

Insurance Policy Number

Questions

When was your pet last fed?

When were your pet's vaccinations last given?

How is your pet today? Any recent ailments we should be aware of? Please tell the nurse if so.

Does your pet have any baby teeth remaining?

Yes

Unsure – Please check

If required, we will add the cost for deciduous teeth removal to the estimate.

Does your pet have hind dew claws that need to be removed today?

Yes

Unsure – Please check

If required, we will add the cost for dew claw removal to the estimate.

Does your pet have an umbilical hernia that needs to be repaired today?

Yes

Unsure – Please check

If required, we will add the cost for hernia repair to the estimate.

Is your pet up to date with tick/flea treatments?

Yes

Unsure

Please list any medications your pet is on and the time the last dose was given:

Does your pet have any allergies to food or medications?

This may be a previous known or suspected reaction to a medication, or a type of food they have an intolerance to. Leave blank if none.

IV fluids:

You can feel comforted knowing that all our patients are treated as required with intra-operative fluids. This allows excellent maintenance of blood pressure throughout the anaesthetic and replaces any fluid or electrolyte loss due to bleeding, sickness or dehydration. It makes every anaesthetic safer and every pets recovery more pleasant. Our patients go home far less affected by the anaesthetic drugs when they have been rehydrated peri-operatively.

Pain relief:

Patients require appropriate pain relief during and after surgery. Your pet will receive appropriate pain relief as part of their stay in hospital today. Your vet may send your pet home with additional medication today if necessary.Should your pet have any adverse reactions to anti-inflammatories of any kind that you know of please make us aware.

Our vets have recommended blood-testing prior to this procedure today for several reasons:

To allow us to choose most appropriate fluid therapy today as indicated by the blood test. This may mean replacing electrolytes and fluids due to blood loss, dehydration or illness. We can also supplement the fluid with glucose if required.
To give us an evaluation of organ function. The kidney and liver are responsible for breaking down the anaesthetic and are the first organs to be adversely affected by anaesthesia.
We also run a CBC (complete blood count) which gives us valuable information about inflammation, clotting ability, anaemias and immune function. Chronic low grade anaemias are sometimes the first markers of disease and can easily go unnoticed.
In addition to organ evaluation and the CBC, the calcium level can act as a marker of early cancer and other disorders.
The cost of your pet’s blood test will be included in your estimate. If you would like any additional tests done, please discuss this with the nurse on admission.

Should your pet have any adverse reactions to anti-inflammatories of any kind that you know of please make us aware at the time of admission.

Estimate provided by vet?(Required)

Yes

If NO, would you like an estimate prior to proceeding today?(Required)

Yes, I would like an estimate provided

No, I do not require an estimate of costs

Estimate of costs:(Required)

Risks and Consent for CPR

All procedures performed under general anaesthesia or sedation carry inherent risks. While every care is taken to minimise these risks through thorough patient assessment, monitoring, and the use of appropriate medications and equipment, complications can still occur.

Acknowledge and understand risks(Required)

By ticking this box and signing this consent form, I acknowledge that these risks have been explained and understood, and I consent to the procedure being performed.

In the unlikely event of an emergency situation with your pet, do you give consent for our team to proceed with life-preserving treatment, including CPR?(Required)

Yes – I authorise the veterinary team to perform all necessary life-preserving measures, including CPR, emergency drugs, and supportive care as deemed appropriate. I understand this will incur additional charges.

Yes, with limitations – I consent to life-preserving treatment; however, only up to a certain monetary amount (please detail in the box below)

No – I do not consent to CPR or advanced life-preserving treatment. I understand that if my pet experiences a life-threatening event, no resuscitative efforts will be performed

I give consent for life preserving measures up to:

Provide a dollar amount here that you are comfortable spending for CPR.

Signature

By signing below, I give my full consent for the procedure(s) detailed above. I have read and understood this form, the choices I’ve selected, and I am the owner of the pet OR an authorised representative of the owner who has been given permission to make decisions on their behalf.

Any other comments or additional things you would like done today? These may incur additional costs.

Do you give us permission to use photos we may take of your pet on social media?

Yes

Payment at Pickup(Required)

I agree to payment of the fees in full when I collect my pet from the clinic.

Owner's signature (or authorised representative over 18yrs of age):

Date