WEATHERFORD EQUINE - SURGERY ADMISSION FORM - CASTRATION
If surgery is required you will need to supply this page with a consent signature
after filling in the form - please print and fax to Weatherford Equine.
EMAIL info@weatherfordequine.com.au
Title:
MR
First Name:
Last Name:
Stud / Stable:
Email Address:
I, Being the owner / agent of the below named animal and a person over the age of twenty-one
years, hereby authorise Weatherford Equine and their registered Veterinarians to castrate the
animal descibed below
Name:
(or Sire & Dam)
Microchip:
Breed:
Brands - NS:
OS:
Colour:
Age / DOB:
In consideration of the said Veterinarian providing the requisite treatment, I hereby agree to
pay the prescribed fees, and further agree to indemnify him, his servants or agents, from loss
or liability which may incur as a result of any inaccuracy whether intended or otherwise in this
my declaration
I consent to this procedure
I do not consent to this procedure
If surgery is required you will need to supply this page with a consent signature
after filling in the form - please print and fax to Weatherford Equine.
Weatherford Equine
400 Wills Road
Emerald Q 4720
Office
(07) 49 877 478
Manager
0418 606 913 Mark Smith
Veterinarian 0417 606 911 Dr Joanne Smith BVSc