Before a Procedure

Your Name

Email Address

Phone number(s) to reach you at, on the day of the procedure

Pet's Name

Scheduled procedure

Pre-op fasting: Pre-op fasting: I have read the fasting instructions above, and ensure my pet will be fasted for their procedure I have received specific instructions from the vet and will follow those No, my pet will not be fasted. (We may not be able to proceed if your pet is not fasted.)

Do you consent to the recommended pre-op bloodwork? Do you consent to the recommended pre-op bloodwork? Yes, please run pre-op blood tests No thank you I'm not sure. I need more information.

Would you like your pet to get a tattoo (in the right ear), for identification, helpful within B.C. Would you like your pet to get a tattoo (in the right ear), for identification, helpful within B.C. Yes please No thanks

Would you like your pet to get a microchip (helpful ID worldwide)? Would you like your pet to get a microchip (helpful ID worldwide)? Yes please No thanks

If fleas are seen on your pet, a short-term treatment will be administered, and there will be a nominal fee. If fleas are seen on your pet, a short-term treatment will be administered, and there will be a nominal fee. Yes, I understand I do not consent to this. (We won't be able to admit your pet to the hospital if we can't treat for fleas, if we see them.)

Is your pet female, and scheduled for a spay surgery? Is your pet female, and scheduled for a spay surgery? Yes No (Pet is not female, and/or not scheduled for a spay)

Has your pet been in heat recently? Has your pet been in heat recently? She has never been in heat She was in heat over 1 month ago She is in heat now, or recently (within a month) I don't know

Pregnancy history? Pregnancy history? No history of pregnancy 1+ pregnancies previously, most recent over 5 months ago Recent pregnancy, recently weaned I don't know

Is your pet on a special diet? Is your pet on a special diet? No special dietary needs. I feed my pet raw. (We need to know this so we can take precautions for immune suppressed individuals.) My pet is on a special diet. Please do not feed my pet any food or treats unless discussed

Is your pet on any medication (aside from parasite control)? Is your pet on any medication (aside from parasite control)? Yes, I will list them in comment section below No medications

Any additional comments, concerns, questions? If so, please include them here.

I give consent for my pet to have the scheduled procedure, and for vets/staff of Bellevue Veterinary Hospital to carry out any treatment that is necessary. I realise that no guarantee can be made regarding outcome/cure. I am aware of the risks of the general anesthesia and/or the procedure. I will be responsible for the fees charged for this service and for following the post-op instructions for my pet. I give consent for my pet to have the scheduled procedure, and for vets/staff of Bellevue Veterinary Hospital to carry out any treatment that is necessary. I realise that no guarantee can be made regarding outcome/cure. I am aware of the risks of the general anesthesia and/or the procedure. I will be responsible for the fees charged for this service and for following the post-op instructions for my pet. Yes. Click SUBMIT to send this consent form to Bellevue Veterinary Hospital No. We will not be able to proceed.