Consent Form with Anesthesia or Sedation

I am the owner or the authorized agent for the owner of the animal described above, and I have the authority to executethis consent. My signature below certifies that I am over eighteen years of age.

I have been informed that there are certain risks and complications associated with sedation, anesthesia, and/or anyoperation/procedure and that the risks/complications have been explained to me. I further understand that during thecourse of the operations or procedures, unforeseen conditions may arise that may necessitate the performance ofadditional procedures deemed necessary by the veterinarian. I am encouraged to discuss any concerns I have about theserisks with the attending veterinarian before the procedure is initiated.

While there are risks associated with general anesthesia, be assured that %practicename% will take every precaution tominimize risk by always performing the following:

  • Physical exam prior to anesthesia
  • Multi-parameter monitoring (blood pressure, EKG, CO2, heart/respiratory/temp)
  • Intravenous (IV) catheter and fluid therapy
  • Preoperative and postoperative pain control
  • Injectable and inhalant anesthetics based on your pet’s age and specific medical needs.

I authorize the use of appropriate anesthesia and pain relief medication as needed before, during or after the procedure. I have been informed that there are risks associated with the use of any medication.

The nature of these operations or procedures has been explained to me and I understand what will be done. I am awarethat the practice of veterinary medicine is not an exact science and, thus, there are no guarantees for successful treatment. I have been encouraged and given the opportunity to discuss any questions I may have regarding my pet's medical careand my questions have been answered to my satisfaction. I accept that my financial obligations remain regardless of theoutcome.

I have read and understand this authorization and hereby accept and agree to the terms of the consent for treatment.

It is important that we have a phone number where you can be reached if consultation is necessary while your pet is under anesthesia:

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