Anesthesia Consent Form

Save time during your next appointment! Complete your required anesthesia consent form online from any device at any time before your visit.

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Anesthesia Consent Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. You can also download the form by clicking the button below.

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Owner’s Name *

First

Last

Phone Number *

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Name of Animal *

Species *

Breed *

Sex *

Type of Surgery *

I, the undersigned, do hereby certify that I am the owner or duly authorized agent for the owner of the animal described above and have the authority to execute this consent. I hereby authorize the performance of professionally accepted general anesthetic procedures necessary for its treatment. I understand that support personnel will be used as deemed necessary by the veterinarian. I have been advised as to the nature of the procedures and the risks involved in performing general anesthesia to the above-described animal. I realize that results cannot be guaranteed. I have read and understand this authorization and consent. I further understand that I assume financial responsibility for all services rendered. *

I agree to the terms and conditions

Flea/Tick Observation

If any fleas/ticks are observed on your pet while at the hospital, he/she will receive a CAPSTAR at the owner’s expense.

Pre-Anesthetic Testing Consent

Your pet is scheduled for a surgical procedure requiring the used of anesthesia. We, like you, consider your pet’s well being to be our highest priority. Prior to anesthesia, we will perform a full physical examination to identify any pre-existing medical conditions that may potentially cause complications. In conjunction with a physical exam, we strongly recommend a Pre-Anesthetic blood test profile. Although the blood profile does not totally eliminate risk, it greatly reduces the possibility of complications and serves to identify conditions that may require future treatment.

Pre-Anesthetic Testing Consent

Any animal 6 years of age and older will be required to have this test performed. Also, any animal having any type of surgery, except spay or neuter, will be required to have this test performed. (If not checked, Pre-Anesthetic profile will not be done for your pet)

Please Check One and Sign if Your Pet is Under 6 Years of Age and is Being Spayed or Neutered. *

Please perform the recommended (Pre-Anesthetic profile 75.00 extra) prior to administering anesthetic to my pet.
I decline the recommended Pre-Anesthetic blood tests prior to administering anesthesia to my pet. I also understand that increased risk of complications by not performing these tests before undergoing anesthesia. I assume full responsibility for this decision concerning my pet’s health.

Name *

This signature acknowledges that the above rights and permissions have been read and understood.

Date *

Anesthesia Consent Form

Anesthesia Consent Form

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