Surgical Consent Form
Owner/Guardian:
Client ID:
Client QATAR ID NUMBER:
.
Pet details:
Procedure:
____________________ (please type here)
Preferred method in case of CAT SPAY procedure - Flank Spay / Middline Spay
Has your pet fasted for 12 hours? YES / NO
Is your pet currently on any medication? YES / NO If yes, please list:______________________
Does your pet have any allergies or problems with anesthetic that you are aware of? YES / NO
PRE-ANESTHETIC BLOOD TESTING (PABT) - *FULL PANEL MANDATORY FOR PETS 7+ YRS*
PLEASE NOTE - We recommend a blood profile screening before anesthesia and surgery to ensure that your pet is
in a low-risk category. PABT has saved the lives of a significant number of outwardly normal patients in this
clinic.
Conditions that may influence the effect of anesthetic agents or medications on your pet may not be evident during the presurgical physical examination. The PABT helps to detect animals which should NOT be anesthetised or have surgery, or
animals which may require special care and monitoring. The PABT checks the functionality of the organs like kidney and
liver, which can be affected by the anesthetic. The PABT also helps to reveal infection not easy to detect during routine
check up. Normal results do not guarantee a positive outcome, but gives useful baseline data for future comparison.
Please perform:
FULL PANEL (600 QR) ☐
BIOCHEMISTRY ONLY (350 QR) ☐
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 (350 QR) ☐
ADDITIONAL SERVICES AVAILABLE:
Initial here to DECLINE FIV TESTING __________
FREE nail clipping & ear cleaning ☐
Microchipping (350 QAR) ☐
Microchipping is mandatory for pets to leave Qatar. Microchipping whilst anesthetised means no pain on insertion .
I authorise 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 realise 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 authorise the use of necessary sedatives and pain medications. I
also authorise 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. I further understand that if QVC is unable to
contact me or I do not contact them for a period exceeding 72 hours, my pet may at the discretion of QVC become their
property and be dealt with as they decide.
If whilst spaying my pet she is found to be pregnant, I authorise QVC to remove the fetus/es at my extra cost.
A deposit of
qr has been paid towards the cost of the surgery, I understand this is a deposit only and the
full invoice may be more which I accept to pay in full.
Signature:______________________________________________ Date:____________________
Phone number(s) where you can be reached today: _________________