Blood Donor Consent Form
Clinic Details
- Date of donation
- Time
Owner's Details
- First name
- Last name
- Phone
Donor's Details
- Name
- DOB (age)
- Microchip
- Weight (kg)
- Gender
- Species
- Breed
- Blood type
- Date of last donation
Donor Screening
- My animal has never received a blood transfusion
- My animal is healthy, up to date with vaccinations and parasite prevention, and not on medication other than routine preventives
- I consent to pre-donation health screening, including blood tests and infectious disease testing, and to being informed of the results
- I consent to sedation if required for safe collection
- Notes
Consent
I voluntarily consent to my animal donating blood at this clinic. I understand that collection involves clipping and cleaning a small area, drawing blood from a vein (usually the jugular), and that possible effects include bruising at the site and transient lethargy, with serious complications being rare. I understand that sedation, where used, carries its own small risks which have been explained to me. I understand that the veterinarian will examine my animal before collection and may decline the donation on the day if it is not in my animal's interest, and that I may withdraw consent at any time before collection. I understand the donated blood may be used for any patient in need, or stored, at the clinic's discretion. I confirm that I am over the age of 18 years and am the owner, or an authorised agent of the owner, of this animal.
- Owner / agent name
- Date signed
Owner / agent signature
- Veterinarian / staff member
- Role
Staff signature
