SVA Consent Form

PLEASE READ THE FOLLOWING CAREFULLY:

You confirm that you understand the risks associated with the anaesthesia and by signing below:

  • You consent to and authorise Sydney Veterinary Anaesthesia performing anaesthesia* on the Pet. The anaesthetic procedure has been explained to you and all questions have been satisfactorily answered.
  • You acknowledge that anaesthesia carries inherent risks and all such risks have been satisfactorily explained to you by a member of Sydney Veterinary Anaesthesia or the admitting veterinary hospital staff.
  • You understand, acknowledge and agree that results cannot be guaranteed and you will not hold Adlie Enterprises Pty Ltd ACN 650 037 291 t/a Sydney Veterinary Anaesthesia liable for any adverse outcome concerning the surgery or the Pet, in any way whatsoever, howsoever arising.

 

*‘Anaesthesia’ may include sedation, analgesic techniques, including regional anaesthesia, and the administration of any and all medications at the discretion of the attending anaesthetist.

Your anaesthetist will be in touch with you after the completion of the Procedure.

 

Further, a photograph or a video of your Pet may be taken and used for educational or promotional purposes in a non-identifiable manner. Tick the below if you do not consent to this

Photo Consent


Patient ID as supplied by surgery

Your pets' name.
Your Contact Email(Required)

Your best contact email

Has the patient fatsed?

When did the patient last have access to food?

When did the patient last have access to water?


Please list all current medications and time of last administration:
Your Name(Required)

Executed as a deed by (Your Name):
DD slash MM slash YYYY


Please sign this form.
PAYMENT

Please enter the amount of the procedure as quoted by the clinic. You can add additional on-the-day extras below:
Blood Test?

Blood Test?
Collar to prevent licking and self trauma?

Collar to prevent licking and self trauma?
Anti nausea injection?

Anti nausea injection?


Procedure Total:


Pay With Credit Card:
This field is for validation purposes and should be left unchanged.