ACR Consent Form - Wallace Vets

Your Cat's Name *

Which practice are you booked into? *

I hereby give permission for the administration of a general anaesthetic and appropriate drugs to the above animal for the surgical procedure which they are booked in for, together with any other procedures which prove necessary.

I understand that all anaesthetic and surgical procedures pose a risk to the animal and that we cannot foresee any associated complications.

I understand that the Wallace Veterinary Centre shall try to contact me if any different treatment is recommended but if unable to do so shall do what they think is in the best interest of the above animal.

I understand that I need to fast this cat from midnight before the procedure?

Tick to confirm

I understand that I need to fast this cat from 16:00 on the day of the procedure?

Tick to confirm

Does this cat have any health problems that we are unaware of? *

Yes

No

Please tell us about your cat's health problems

For Cats over the age of 10 we recommend pre-anaesthetic blood test to check liver and kidney function, and fluids to maintain blood pressure and reduce affects of anaesthetic on the organs.

Would you like us to carry out a pre-anaesthetic blood test? *

Yes

No

Would you like us to use fluids throughout the procedure? *

Yes

No

Do you have any further information you would like to add?

By signing below you are agreeing that you are the owner of the above named animal or are authorised by the owner and that you acknowledge that payment for this procedure is due at the time of discharge.

Signature *

Clear

Angus Cat Rescue Consent Form