Pre Surgical Assessment - Kalinga Park Veterinary Surgery

1Details of Hospital Stay

2Your Details

3Pets Details and Anaesthetic History

4Fluid Therapy Consent

5Preanaesthetic Laboratory Testing Consent

6General Consent

Date(Required)

DD slash MM slash YYYY

Expected Procedure(Required)

Additional Procedures

Clip Nails

Express Anal Glands

General Vaccinations

Heartworm Treatments

We cannot guarantee we can perform this work but will give it our best efforts. If may be precluded or contraindicated in which cas we will inform you at checkin. You can select more than one.

Additional Procedures not listed above

Email(Required)

Name(Required)

First Last

Phone(Required)

Alternative Contact Phone Number

Pets Name(Required)

Has your pet ever had a anaesthetic performed at another vet surgery? If yes please enter the date and the name of the surgery where that procedure was performed.

Yes my pet has had anaesthesia elsewhere

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Anaesthesia Elsewhere

Type of Surgery(Required)

Veterinary Surgery Name(Required)

Date(Required)

DD slash MM slash YYYY

Are you aware of any condition that may affect your pets ability to tolerate an anaesethetic? (Enter details in the comment field)

YES

Conditions you feel affect your pets ability to tolerate anaesethesia

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General Info

Has your pet had any general blood test in the past 6mths? If it wasnt done at Kalinga or Ascot please give us the details.(Required)

Yes at Ascot / Kalinga

Yes at another surgery

Details of the Blood Tests(Required)

Please enter any other relevant information about your pet and surgery you think we need to know.

Intravenous Catheterisation and Fluid Therapy(Required)

I agree to the fluid therapy

All pets undergoing anaesthesica at Kalinga Park received supportive fluid therapy. This involves a catheter placed in the front leg.

Preanaesthetic Laboratory Consent

Do you consent to your pet having a preanaesethetic blood test?

We recommend all pets recieve a blood test prior to surgery. Further information can be found in the links to the left.

Link to Information about blood tests

Costs of this test may have been included in the estimate you received if not our staff can provide details on the day of surgery

We ask your pet not receive any food in the 4 hours before admission on the day they are due to have surgery. Continue to give them water but restrict food.

All pets should be presented clean and dry – if your pet has been swimming in the days prior at a creek or lake – please ensure they have been bathed in clean fresh town water to ensure no unusual bacteria remain on their coat

I DECLARE THAT:

I am 18 years of age or over,
I am the owner of this pet OR* that I am authorised by the owner to sign this form
I authorise all procedures to be performed as recorded on this form
I understand that these procedures may be performed by (and/or under the supervision of) any qualified member of our staff
I have discussed any health concerns about my pet with the veterinarian
I understand the risks associated with medical/surgical procedures and that in the event of a complication additional fees may be incurred
I consent to photos of my pet being used for social media purposes
I agree to pay all veterinary fees associated with this procedure at time of discharge

Consent(Required)

I accept these conditions

Signature(Required)