CAT Program Desexing Consent FormPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Client DetailsName *FirstLastPhoneAddressAddress Line 1Address Line 2City--- Select state ---Please SelectSouth AustraliaWestern AustraliaVictoriaNew South WalesQueenslandTasmaniaAustralia Capital TerritoryNorthern TerritoryState / TerritoryPostalPet DetailsCat's NameBreed/Colour/Distinguishing FeaturesAge/DOBSexFemaleMaleCheck all that apply:OK with being picked up.Timid, may bite/scratch.Unsocialised likely to bite/scratchReason for visit:DesexingMicrochipFlea/Worm TreatmentCurrent Injuries/Illness/Medications Details last Cat's Pregnant/in season/had kittens in last 6 weeks?Has your Pet been Fasted for Surgery?YesNoWhen did cat last eat?ConsentI am over the age of 18 years and am the owner or agent for the owner of the above-described animal and have the authority to execute this consent. I hereby authorize AWLQ Inc. to perform all procedures as recorded on this form. I understand that during the performance of the procedures, unseen conditions may be revealed that necessitate an extension of the procedure. Therefore, I hereby consent to and authorize the performance of such procedures as are necessary and desirable in the exercise of the veterinarian's professional judgement. I understand that these procedures may be performed by (and/or under the supervision of) any qualified member of our staff. I assume financial responsibility for charges incurred to the patient. I am aware that my pet is scheduled for a procedure that requires anaesthesia / sedation. I understand that although all reasonable precautions and due care will be taken; there is always a potential risk with any medical/surgical procedure, including death. I accept these risks and authorise AWLQ Inc. to perform such treatment as deemed necessary. I acknowledge that the AWLQ Inc. takes careful measures that patients at the clinic will not be exposed to contagious illnesses whilst they are on the premises. I recognize that if my pet is affected by contagious disease while at the clinic and my pet does not have a current vaccination history I am financially responsible for costs of treatment. I will ensure that I am able to respond to the phone number provided throughout my cat’s stay at the clinic. consent *I agree to the terms and conditions.Full Name *My signature on this form indicates that any questions I have, have been answered to my satisfaction and I consent for the treatments/procedures to go ahead.Signature * Clear Signature Submit
CAT Program Desexing Consent FormPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Client DetailsName *FirstLastPhoneAddressAddress Line 1Address Line 2City--- Select state ---Please SelectSouth AustraliaWestern AustraliaVictoriaNew South WalesQueenslandTasmaniaAustralia Capital TerritoryNorthern TerritoryState / TerritoryPostalPet DetailsCat's NameBreed/Colour/Distinguishing FeaturesAge/DOBSexFemaleMaleCheck all that apply:OK with being picked up.Timid, may bite/scratch.Unsocialised likely to bite/scratchReason for visit:DesexingMicrochipFlea/Worm TreatmentCurrent Injuries/Illness/Medications Details last Cat's Pregnant/in season/had kittens in last 6 weeks?Has your Pet been Fasted for Surgery?YesNoWhen did cat last eat?ConsentI am over the age of 18 years and am the owner or agent for the owner of the above-described animal and have the authority to execute this consent. I hereby authorize AWLQ Inc. to perform all procedures as recorded on this form. I understand that during the performance of the procedures, unseen conditions may be revealed that necessitate an extension of the procedure. Therefore, I hereby consent to and authorize the performance of such procedures as are necessary and desirable in the exercise of the veterinarian's professional judgement. I understand that these procedures may be performed by (and/or under the supervision of) any qualified member of our staff. I assume financial responsibility for charges incurred to the patient. I am aware that my pet is scheduled for a procedure that requires anaesthesia / sedation. I understand that although all reasonable precautions and due care will be taken; there is always a potential risk with any medical/surgical procedure, including death. I accept these risks and authorise AWLQ Inc. to perform such treatment as deemed necessary. I acknowledge that the AWLQ Inc. takes careful measures that patients at the clinic will not be exposed to contagious illnesses whilst they are on the premises. I recognize that if my pet is affected by contagious disease while at the clinic and my pet does not have a current vaccination history I am financially responsible for costs of treatment. I will ensure that I am able to respond to the phone number provided throughout my cat’s stay at the clinic. consent *I agree to the terms and conditions.Full Name *My signature on this form indicates that any questions I have, have been answered to my satisfaction and I consent for the treatments/procedures to go ahead.Signature * Clear Signature Submit