Qatar Veterinary Center
Surgical Consent Form
Owner/Guardian
Pet Name
Procedure(s)
Breed
Sex
Age
Weight
M / F
kg
Has your pet fasted for 12 hours? YES / NO
Is your pet currently on any medications? YES / NO If yes, please
list:_______________________________________
Does your pet have any allergies or problems with anesthetic that you are aware of?
YES / NO
I authorize the Qatar Veterinary Center (QVC) to perform diagnostic, therapeutic and or surgical procedures
as agreed. These services have been described to me to my satisfaction. I realize that no guarantee can
be ethically or professionally made regarding the possible outcome or cure.
I accept that anesthesia or sedation have inherent risks. I authorize the use of necessary sedatives and pain
medications. I also authorize QVC staff, in an emergency situation to follow through with such procedures
necessary for the well being of my pet on a continuing basis until further communication with me is possible.
Signature:__________________________________________________________ Date:__________________________
Phone number(s) where you can be reached today: ________________________/________________________
PRE-ANESTHETIC BLOOD TESTING (PABT)
We recommend a blood profile screening before anesthesia and surgery to ensure that your pet is in a low-risk category.
Conditions that may influence the effect of anesthetic agents or medications on your pet may not be evident during the
pre-surgical physical examination. The PABT can help to detect animals which should NOT be anesthetized or have
surgery, or animals which may require special care and monitoring. The PABT measures liver and kidney enzymes, total
protein, glucose, white blood cell count, hemoglobin and other red blood cell parameters.
Normal results do not
guarantee a positive outcome, but gives useful baseline data for future comparison.
PLEASE PERFORM THE FULL PANEL (450 QR)
YES / NO
PLEASE PERFORM BIOCHEMISTRY ONLY (250 QR)
YES / NO
INITIAL HERE TO DECLINE ALL PRE-ANESTHETIC BLOOD TESTING ___________
FELINE IMMUNODEFICIENCY VIRUS TESTING (FIV, FELINE AIDS VIRUS) Cats only
A rapid in-house test that can identify antibodies to this common issue in outdoor cats. Identification of infected cats via
testing allows the veterinarian to develop a long-term management plan for cats that are positive.
PLEASE PERFORM FIV TESTING ON MY CAT (300 QR)
YES / NO
INITIAL HERE TO DECLINE FIV TESTING__________
ADDITIONAL SERVICES AVAILABLE 
Nail Clipping (60 QR) ☐
Vaccination Updating (180 QR per vaccine) ☐
Microchipping (350 QR) ☐