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ADMISSION FORM
If you are new to our clinic, please also fill out the New Client Details form at this link
Name of Client
Address
Dog Cat Other
Breed
Colour
Age or Date of Birth
Name of Pet
Your pet is being admitted for the following procedures for an approximate fee of ...
$
Please tick all procedures that your pet is having done today. Note: unless it is ticked by you we will not be doing the procedure.
General Anaesthesia
Tick
Desexing
(surcharges applyfor animals over 18 months of age, those in season, pregnant or excessively overweight). Note a desexing tattoo is used on all animals it is placed in the ear and is a permanent record of desexing. You must tell us in writing if this is not to be done.
Tick
Vaccination
Tick
Dentistry
Tick
Dental Extractions
Tick
Surgery (please specify)
Microchipping
Tick
Xrays
Tick
Other (please specify in your own words)
Would you like pre-anaesthetic blood tests to be performed? ($80)
We suggest that any animal over 8 years of age have pre-anaesthetic blood tests performed; it is highly recommended that other animals are also tested. High enzymes can indicate potential kidney and liver failure. In young animals 5% of patients benefit from these tests and in older animals up to 95% benefit
Tick
Would you like your pet to have added pain relief over the next 2 days? (extra $15)
Tick
Is your pets vaccination status current?
Tick
Is your animal on a heartworm preventative?
Tick
Accessories left with animal:
Carry Cage
Tick
Lead/Collar
Tick
I, as the authorized agent or owner understand these procedures and accept the risks involved.
I authorise them to be carried out and agree to pay the fees at the time of disharge.

Please tick the following box. By doing so you acknowledge the fact that you have read and understand the form, authorize the procedures ticked and accept the risks involved.

Please note if this box is not ticked we cannot proceed...

 Tick
If day contact is required, please leave your contact details below
Today's date (DD/MM/YY)
Day Contact (Yes/No)
Do you wish to get a a phone call? Phone number
SMS number
Email address

Name of authorising agent/owner

Please follow this link to make an Appointment