Surgery Consent Form | The Village Vet Killara and Pymble

Which Clinic are your visiting?(Required)

Pymble

Killara

Procedure

Patient:

Weight

Age

Customer

Phone

Alternative Contact No. if different for today:

Insurance

Do you have Pet Insurance?

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

Policy Number

Questions

When did your pet last eat?

Please record any current medications your pet is on:

When was the last dose given?

Here at Village Vet we take every surgery seriously:

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 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 Testing 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.

Estimate provided by vet?

Yes

If “No” would you like an estimate prior to proceeding today?

I would like an estimate provided

Since we cannot always be sure what we are going to find and how long a procedure may take we usually provide you with a high and low estimate to give you a range of best/ worst case scenario.

Any other comments or additional things you would like done today

Permission to use any photos we may take on social media

Yes

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

Date

Internal only

Procedure:

Patient ID:

Customer ID:

Insurance

Questions

Here at Village Vet we take every surgery seriously:

Internal only

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