Surgery Consent Form (02) 9388 2551 Book Online Please fill out the Surgery Consent Form prior to your pet's surgical procedure at Rose Bay Vet Hospital Surgical Consent Form Client Name: * Contact Number: * Email: * Patient Name: * Sex: * Breed: * Age: * Procedure: * Patient History Has your pet ever had an allergic reaction to any medications? * Yes No Has your pet eaten in the past 12 hours? * Yes No Has your pet been unwell in the past 48 hours? * Yes No If yes, what are the symptoms? Is your pet on any medications? * Yes No If yes, give details and last dose given: At the time of desexing we recommend starting the heartworm injection.This replaces monthly tablets, and you will receive a yearly reminder at the same time as your dogs vaccinations. For Laparoscopic speys ONLY: I understand in the unlikely event of bleeding, adhesions or any other complications, a routine open spey will be performed. I consent to the administration of a sedative and/or anaesthetic to the above animal. Yes No All patients undergo pre anaesthetic blood testing to detect major organ abnormalities that may complicate the anaesthetic and identify any underlying medical conditions that require treatment. The results also form a good baseline measure of your pet's health. If you do not wish to have pre anaesthetic blood test prior the procedure, please opt out here: Opt Out I understand the cost of treatments involved and undertake to pay this on collection of my pet. In the event of circumstances arising requiring further treatment or surgery, I give authorisation to such procedures deemed necessary in the opinion of the veterinary surgeon and understand that these may incur extra costs. I understand and accept that all treatments, anaesthetics and surgical techniques involve risk to the animal, including risk of death and I accept such risk, given all reasonable skill and care is taken by the veterinary surgeon and support staff. Signature signature keyboard Clear Captcha Submit If you are human, leave this field blank. (02) 9388 2551 Book Online