&es &bs Practice Name and Address &bf &ef

&bs OPERATION CONSENT FORM &bf

&client
&address1
&address2
&address3
Tel &ffield

&bs DESCRIPTION OF PATIENT &bf
Client Number &ref
&animal
&species
&breed
&age
&sex


&bs  OPERATION :  &opp  &bf

I hereby give my permission for the administration of an anaesthetic to
&animal  and to the surgical operation as detailed on this form, together
with any other procedures which might prove necessary.

I understand that all anaesthetic techniques and surgical procedures may
involve some risk to &animal

In order to minimise the risks we will perform a full physical examination
on &animal  however we highly recommend a pre-anaesthetic blood test to
eliminate many pre-existing problems that may not be evident physically,
but which could lead to problems.

The cost of this blood test is #32.54

&bs I DO / DO NOT &bf wish the pre-anaesthetic blood test to be performed.

I understand that the complete fee is payable at the time of discharge.






Signature of Owner or Agent





Date







.pa