CT Booking Form

I confirm that the patient is compliant with the statements below; if not, please detail in the relevant history box.

  • Has no known heart or renal problems
  • Does not have any metal fragments in eyes or any other part of the body
  • Has not had any operations involving the insertion of metal implants, plates or clips
  • Does not have any type of electronic, mechanical or magnetic implant (excluding microchip)
  • Has not had any surgery in the previous two months
  • Is not pregnant

I confirm that I am a qualified veterinary surgeon who has obtained consent from the patient’s owner to act on behalf of the patient described above. The client has given permission for the administration of an anaesthetic to the above animal at Optivet Referrals, together with any other procedures which may prove necessary. The client understands that in the unlikely event of an emergency or where additional pain relief or sedation may be required, Optivet Referrals will act in the best interests of the patient. The client has agreed that they have understood that medicines may be used which are not licensed for use in dogs and cats.

In the event that I cannot be contacted on the above number, I understand that Optivet Referrals will act in the best interests of the patient.