.pl 64
.cp 2                                                                      
                     &bs&es &pname &ef&bf                                   
&pad1                                                                        
&pad2                                                                        
&pad3                                                                        
                                                                             
               OPERATION CONSENT FORM FOR &animal (&ref)                     
                                                                             
&client                                   &breed                             
&address1                                 &age                               
&address2                                 &sex                               
&address3                                                                    
                                                                             
                                                                             
Operation :&bs &opp &bf                                                      
                                                                             
Operation date: &bs  &odate &bf                                              
                                                                             
Estimated cost (including VAT):&bs  &price  &bf                              
                                                                             
                                                                             
I hereby give my permission (certify that I have the owners permission)      
for the administration of a general anaesthetic to the above animal and      
to the surgical operation detailed on this form, together with any other     
procedures which might prove necessary.                                      
                                                                             
I understand that all anaesthetic techniques and surgical procedures         
involve some unforeseen risk to the animal for which the surgeon             
cannot be held liable.                                                       
                                                                             
I further undertake to settle all outstanding fees before the animal         
is collected following surgery or treatment.                                 
                                                                             
                                                                             
Signed ..................................                                    
                          &client                       &date                
                                                                             
&bs                                                                          

Telephone:.......................(Home)   ......................(Business)    

IMPORTANT - WE MAY NEED TO CONTACT YOU 

Contact Telephone Number for today..............................&bf       
                                                                             
_____________________________________________________________________________





&es   IDENTICHIP YOUR PET NOW - (electronic pet tag) &ef

I would like to take the opportunity to have the IDENTICHIP implanted
while &animal  is under anaesthetic.

           COST:    #25.00 (INC VAT)      (#21.28 EX VAT)


YES..........    NO.........    Signed...................................