Orthopaedic / Soft Tissue Surgery Admission Form

You are here: Home1 / Faxbridge Veterinary2 / Forms3 / Orthopaedic / Soft Tissue Surgery Admission Form

Orthopaedic / Soft Tissue Surgery Admission Form

Please complete the form in full.

Please enable JavaScript in your browser to complete this form.

Preferred Clinic for Admission *

Clonakilty
Bandon

Please select the clinic where you wish to have your pet admitted.

Pet Name

Breed

Neutered

Weight

*In Kgs

Microchip No.

Sex

Age

Insurance Company

Patient ID

*if you know

Owners Details

Full Name

First

Last

Photography 6 Full

Email Address

Phone Number

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Please indicate preferred option for patient updates/discharge information

Consent Statement 1 *

I hereby give permission for the admission of the above name pet to Faxbridge Veterinary for Orthopaedic / Soft Tissue Surgery

I consent to the following EXTRA procedures while my pet is hospitalised:

Full Blood Tests €106.50
Pre-GA Blood Test €49.50
Feline Felv/Fiv Test €45.00
Fluid Therapy
Overnight stay + food €38.50 - €45.00
Ultrasound In House €55.00
X-Rays

Consent Statement 2 *

I understand that Faxbridge Veterinary does not provide any credit unless arranged under special circumstances with the manager or treating veterinarian.

Consent Statement 3 *

I understand that all anaesthetic procedures carry a risk, and that the staff at Faxbridge Veterinary endeavour to reduce those risks at all times.

Consent Statement 4 *

I agree to pay 50% of the total cost prior to the procedure, and the remainder upon collection of my pet.

Consent Statement 5 *

I understand that if my pet is insured, I must pay the entire bill upon collection, and then submit a claim to the insurance company for compensation thereafter.

Consent Statement 6 *

I have received/would like an estimate. I am aware that this is only an estimate and that additional costs may occur. I acknowledge that I will be contacted to approve all treatments and procedures.

Consent for Photography and Social Media Use *

Yes, I give my consent
No, I do not give my consent

I give permission for Faxbridge Veterinary to take photographs and/or video recordings of my pet while under their care, and to use these images for promotional purposes, including but not limited to social media platforms.

Signature *

Clear Signature

Date *

Opening Hours

Clonakilty
Mon-Fri: 9am-6pm
Sat: 9am-1pm
T: 023 88 33252

Bandon
Mon-Fri: 9am-6pm
Sat: 9am-1pm
T: 023 88 41842

24/7 Emergency Services
T: 023 88 33252

Small Animal Socials

Instagram
Facebook

Large Animal Socials

Instagram
Facebook

Services

Small Animal Care
Small Animal Surgical Services
Equine
Farm Animals
Farm Shop and Small Animal Health Centre

Faxbridge Veterinary Socials

Tik Tok
LinkedIn