REVS Castration Consent Form

Name*

First NameLast Name

I {name},
Being a person over the age of eighteen years, hereby authorise a registered Veterinary Surgeon employed by Riverina Equine Veterinary Services to administer a suitable anaesthetic, and to perform castration surgery on the animal described below. I acknowledge that no surgical or general anaesthetic procedure is without some risk and that possible complications include general anaesthetic dangers, and that post-surgical complications including haemorrhage (bleeding), eventration (omentum or intestines prolapsing out of the castration wound - infrequent but life threatening) and infection (serious infection can be destructive and expensive). I acknowledge that post-operative care may be required and will be undertaken as deemed necessary by the attending veterinarian. Post-operative visits, if required, will be charged at standard REVS prices and will include travel costs.
Regular castration is performed in the field environment with the horse under general anaesthetic using an open castration technique. Either Crushing or Henderson (drill) emasculators will be used at the attending veterinarian’s discretion unless a preference in technique is stated prior.

Animal Name*

If unnamed, please use dam's name and year born. (e.g Lucky Lady 2023)

Animal Colour*

Animal Colour

Age of Horse*

Age of Horse

Breed of Horse*

Breed of Horse

Horse's Microchip Number (if known)

Microchip number

Brand Left Hand Side

Brand Right Hand Side

Horse Owner's Name*

Owner's name

Phone Number*

Phone Number

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState

Post Code

Insurance Company (if applicable)

Insurance company

Ownership Declaration*

I am the owner of the above named horseI am an authorised agent of the owner

Declaration:

I undertake to pay all costs incurred in this procedure. I agree to your trading terms of payment at the time of discharge (unless other terms have been arranged prior to surgery). If a delayed payment plan is negotiated, I agree to pay all outstanding costs associated with any account within 7 days. I agree that I will be liable for all costs associated with the recovery of any outstanding invoices. Such costs include all Debt Collection, at the agreed rate of 28% plus GST, and Legal Costs at the rate charged by the Legal Practitioner or Court.

I agree to indemnify the attending veterinarian, his servants and agents for any loss or liability that they may incur as a result of any inaccurate information provided on this consent form, whether intended or otherwise.

If the animal is insured, I have informed and gained consent from the above animal’s insurance policy provider to present it for surgery as detailed above.

Declaration:

I am authorised by the abovementioned horse's owner to present the patient for surgery as detailed above. (If signed by an agent of the owner, the agent warrants that he/she has fully authority from the owner to provide the consent and the information contained in this Consent Form).

I undertake that the owner will pay all costs incurred in this procedure. I agree to your trading terms of payment at the time of discharge (unless other terms have been arranged prior to surgery). If a delayed payment plan is negotiated, I agree to pay all outstanding costs associated with any account within 7 days. I agree that I will be liable for all costs associated with the recovery of any outstanding invoices. Such costs include all Debt Collection, at the agreed rate of 28% plus GST, and Legal Costs at the rate charged by the Legal Practitioner or Court.

I agree to indemnify the attending veterinarian, his servants and agents for any loss or liability that they may incur as a result of any inaccurate information provided on this consent form, whether intended or otherwise.
If the animal is insured, I have informed and gained consent from the above animal’s insurance policy provider to present it for surgery as detailed above.

Signature*

Date*

Date