&bs&es&pname&ef&bf                                                           
&pad1                                                                        
&pad2                                                                        
&pad3                                                                        
                                                                            
           REQUEST FOR COMPULSORY SURGICAL NEUTERING OF A DOG

&client                                      &animal (&ref)
&address1                                    &breed
&address2                                    &age
&address3                                    &sex

Operation : &opp
Operation date: &odate

Estimated cost (including VAT):  # &price

I am the OWNER / AGENT FOR THE OWNER  of the dog described above.  I am
over 18 years of age and I request the surgical neutering of this dog.

I undertake to pay the operation fee at the time of collection following
surgery.

I understand and accept that all anaesthetic techniques and surgical
procedures involve some unforeseen risk to the animal, for which the
surgeon cannot be held liable.

I also understand that there are:

         1) Extra risks associated with anaesthesia of an excitable or
        unruly animal involving the restraint necessary for handling.

         2) A risk of post operative complications, for which it may be
        necessary to anaesthetise the dog, again with similar attendant
        risks, and for which there will be an additional charge.

         3) The possibility of unforeseen side effects of neutering.

I understand that the undertaking of this surgery does not imply an
opinion on the breed of this animal.

I confirm that this dog has not had food or water for ........ hours.

     Description:....................................................
     (coat colour / distinguishing marks etc)

     Tatoo Number:.........................

     Microchip Number (if already implanted):........................


     Signed:.....................................   Time:............

         &client                                    Date:    &date

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