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Online Consent Form

Your pet's gender:
Is Your Pet Insured?:
Is your pet a member of our Pet Health Club? :

Please answer the following questions, based on your pet's scheduled time of admission for their procedure

Note - small mammals, as well as puppies and kittens, should not be starved prior to anaesthesia.
If yes - please provide command details
Have they passed urine today?:
Have they had a bowel movement today?:
Do they have any food intolerances? :
Has your pet been unwell since the appointment was scheduled? :
Does your pet have any known underlying health problems or conditions?:
Is your pet on any medication?:
Has your pet ever had a seizure? :
Is your pet up to date with his/her vaccinations? :
Has the sex of your pet been confirmed? :
Has your pet been neutered? :
For bitches, have you noticed any signs of coming into season?:
(E.g. swollen vulva, blood spotting, nesting behaviour, enlarged teats, lactation etc.)
Does your pet suffer from any allergies? :
Has your pet ever had an anaesthetic before? :
If your pet has had an anaesthetic, were there any reported complications? :
Have you been provided with an estimate for the scheduled procedure? :
(Note: during Covid-19 we kindly request that all own leads and harnesses are removed from dogs at the time of admission. Bedding will not be accepted. Cat baskets should be cleaned, and with minimal bedding only.)

Additional Optional Procedures

Free on PHC or Extra charge if not

 

Would you like your pet microchipping during their procedure (free on phc or extra charge if not)?:
Would you like your pet’s nails to be clipped (free on phc or extra charge if not)? :
Does your pet require expression of their anal glands (free on phc or extra charge if not)?:
Would you like us to supply you with a recommended easily-digestible diet for your pet, following their sedation/anaesthesia? This helps combat the delayed gut transit that is often experienced after such procedures (which may result in diarrhoea and/or constipation)? :
(25% off on PHC)
If no - please enter neither/not applicable

We perform pre-anaesthetic blood testing based on the following criteria;

 

• If there is a clinical indication based on history or physical examination for pre-anaesthetic blood screening, then this should be performed on the advice of the vet, as per your itemised estimate received. This helps reduce avoidable risks posed by the anaesthetic and/or sedative agents used.

 

• For pets over the age of 8 years then this is strongly recommended prior to any procedure being performed under sedation or general anaesthesia.

 

• Even testing younger patients is advisable, as we then have on file what is normal for your pet.

 

• Normal results are our favourite type of result, as these allow us to proceed with confidence.

 

• If these have not been included in your estimate received, then these will incur an additional charge. The fee is £45-100, depending on the tests recommended by the vet, which are based on your pet’s age and health. A young healthy dog in for castration would be £45. An old thin cat with a heart murmur in for a dental may be up to £100.

 

• If there is a clinical indication based on history or physical examination for pre-anaesthetic blood screening, then this should be performed on the advice of the vet, as per your itemised estimate received.  This helps reduce avoidable risks posed by the anaesthetic and/or sedative agents used.  

 

*Please note that if pre-anaesthetic bloods are declined against the advice of the vet, then your pet’s scheduled operation may be postponed pending further discussion of the risks involved.

Legal Consent

 

I hereby give my permission for the administration of a sedative or anaesthetic (if applicable) to my pet as named on this form. 

 
Furthermore, I consent to the investigative procedure/surgical operation detailed on this form, together with any other additional necessary procedures. The details of the planned procedure(s) have been explained to me, and I am aware of the associated risks and complications (including death) in the case of general anaesthesia or sedation. I understand that all anaesthetic techniques and surgical procedures carry an element of unavoidable risk.
 

 
I confirm that the anticipated costs have been estimated, but that in the event of further treatment being required, or if complications arise which require emergency treatment, then these will incur additional costs. I understand that Congleton Veterinary Centre shall contact me as soon as practical and safe to do so, in order for me to provide verbal consent for such treatments and additional costs. However, in the event of emergency lifesaving intervention being required, I hereby give my consent for Congleton Veterinary Centre to act in the best interests of my pet’s health and welfare. I accept any associated costs and consequences of such actions. I understand that depending on the nature of intervention required, then these costs could amount to hundreds of pounds (e.g. extended cardiopulmonary resuscitation (CPR), in the case of unexpected cardiopulmonary arrest).
 

It may be necessary for Congleton Veterinary Centre to administer medication(s) to my pet that is/are not licensed for his/her species under the cascade system, but which are applicable to the treatment required.  I understand and give my consent to this.

 
 

If your pet is coming in for a dental procedure, we recommend that very loose teeth are extracted at the time of their scale and polish.  Complications of dental extractions include but are not limited to fracture of roots and their unintentional retention, bleeding, trauma to adjacent dental and soft tissues, swelling under the tongue and salivary mucoceles, trauma to the eye, reduction in alveolar bone height, fracture of the jaw or bony socket of the root (alveolus), oronasal communication, and wound breakdown.  Tooth extraction may also alter normal tongue positioning in the mouth, once recovered.  Complications can also arise following the administration of local nerve block analgesia.  We shall of course be taking every precaution possible to avoid such complications!

I understand and give my consent to my pet's dental procedure.

Payment

I am aware that full payment is required at the time of my pet’s discharge, and I intend to make payment by the following means:



(Please type your full name)
 

Please note, a copy of this completed consent form shall be returned to you by email, once received by Congleton Vets. 

We shall also print a copy, to receive your hand-written signature at the time of admission.

 
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