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Medical procedure agreement

In order to provide all our surgical patients with the best care, we like to be well prepared. We therefore ask for your cooperation in filling out this form below in advance to prevent misunderstandings afterwards.

Describe the treatment your pet is coming for. Should tissue be sent for examination, if advised?

Are you aware of the risks of the procedure and the anesthesia?
Yes
No
Please explain

Every anesthesia involves a risk, we keep this risk as low as possible by examining your pet thoroughly beforehand, adjusting the anesthesia as closely as possible to the age and weight and monitoring your pet closely during the anesthesia.

Has your pet been under anesthesia before and how did it go?
Yes
No
How did the anesthesia go?
Does your pet show any of the following symptoms?
Do you want a basic pre-anaesthetic blood tests of organ functions?
Yes
No

The costs are €78,-

Do you want extended pre-anaesthetic blood tests of all organ functions and hematology?
Yes
No

The costs are €166,-

Does your pet need to be chipped?
Yes
No

The costs are €45,-

Do the nails need to be cut?
Yes
No

The costs are €15.60

Would you like us to put on a medical pet shirt after the treatment?
Yes
No

If applicable, to protect the wound

Is your pet known to have an allergy?
Yes
No
If so, what is your pet allergic to?
Is your pet free of fleas?
Yes
No

If we find fleas, we are forced to treat the animal. Costs will be charged for this.

Sometimes animals suffer from nausea after anesthesia. Would you like us to administer a preventive anti-nausea injection (Maropitant from €23)?
Yes
No
Can images of your pet be taken and used on our social media?
Yes
No
Are you aware of the costs?
Yes, I have taken note of the price indication that was sent
No

By signing this form you agree to the processing of your pet.

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