Grooming with/without sedation Consent Form

Welcome to The Village Vet!

Please complete the following details.

Grooming with sedation Consent Form

Which Clinic are your visiting?(Required)

Pymble

Killara

Pet's Name

Weight

Age

Customer

Address

Contact Phone Number

Questions

When did your pet last eat?

What is your pet having done today?

Full Clip including sedation, please give a brief description of what you would like done:

Other, please give a brief description of what you would like done

Please give a brief description of what you would like done:

Your pet is receiving sedation or an anaesthetic today. If it has never had a blood test before, a blood test has not been completed in the last 12 months, or your pet is over the age of 7 then our vets highly recommend blood-testing prior to this procedure today. This is for several reasons. A few are listed below:

1. To give us an evaluation of organ function. The kidney and liver are responsible for breaking down the anaesthetic/sedation and are the first organs to be adversely affected by anaesthesia.
2. Through evaluation of the blood count we can establish levels of hydration and assess if any anaemia is evident or whether your pet needs rehydration before we proceed.
3. If the blood test is normal then we now have a base-line for your pet for future reference.

Blood Test Approval

Yes – I am happy to proceed with the blood test at an additional $198

No – I decline the blood tests having read the above

Additional procedures- please indicate below:

Bravecto for ticks/ fleas (free nurse application if you provide or you can purchase today)

Intestinal worming (free nurse application if you provide or you can purchase today)

I would like a Vaccination or General check up with the vet

Nail clip

Is your pet up to date with vaccinations?

Yes

No

Proof of vaccine if not a regular client

Yes

No

Estimate provided by vet?

Yes

No

Today's Estimate Service Cost

If "No" would you like an estimate provided before proceeding today?

Yes

No

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

Date

Submit