Anesthesia Consent Form


I have been informed of the risk and potential complications of the procedures.

  1. I have been given no guarantee of the success of the procedures or treatment.
  2. I understand that the hospital will provide an estimate for the routine procedure. I understand that this is only an estimate and due to the nature of the practice of medicine, unforeseen events, complications, or medication that may have to be sent home, this may increase fees beyond the estimate.

Client Initials

Client Initials
I would like my pet to have the following additional procedures while sedated:

Nail Trim(Required)

Routine Ear Cleaning(Required)

Anal Gland Expression(Required)

By signing this agreement, I am agreeing to all the above and I have the authority to authorize consent for the above-named animal to be placed under anesthesia and have the following procedure done.
If I have someone else bring in my pet for their procedure check in appointment, I give the following person permission to make decisions on my behalf.

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