Referral Form
Medical records can be emailed, including radiographs, to Eugene
Where consultation with the surgeon has been declined, I have discussed relevant treatment options with the owner(s) and have ensured that they are aware of the risks associated with surgical procedures including the prescribed procedure, as well as potential after care responsibilities. I have recommended that the patient have complete blood counts and biochemistry panels performed to ensure there are no other underlying health conditions. I agree to release any relevant medical records and imaging associated with the patient’s condition to CAS in order for them to perform their service. I acknowledge that if this information is not received by CAS within 48 hours of the tentative booking time listed below that the booking time will be forfeited. I understand that in unforeseen circumstances, the above booking may need to be rescheduled and have informed the owners of such. I acknowledge that a Client Consent form will be forwarded to my clinic which will be given to the client to read and sign. I will endeavour to discuss any listed complications with the client. I will ensure that this form is accurately completed and signed prior to the animal undergoing general anaesthesia and surgery. The original signed copy will be handed to the surgeon immediately prior to surgery.