Radiology and Ultrasound Consent Form | The Village Vet Killara and Pymble

Which Clinic are your visiting?

Pymble

Killara

Patient Name

Customer

Phone

Last feed for Pet

When was your pet last fed?

Please list any medications your pet is on/ when it was last given:

Yes

If you wish to claim for today please let a nurse or receptionist 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

Please let the nurse know if you would like us to submit the claim for you today.

How is your pet today/ how has your pet been at home? Please note below.

Blood Tests Our vets highly recommend 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.

Blood Test Approval

Yes - I am happy to proceed with the blood test at an additional $187

No - I decline the blood tests having read the above

Permission to use on social media

Yes

Owners signature (or carer over 18yrs of age):

Any other comments or notes

Estimate provided by vet

Yes

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