Anesthesia Consent

The Anesthesia Consent Form allows pet owners to provide permission for procedures requiring anesthesia and related care. Completing this form ensures our team can safely perform necessary treatments while keeping you informed and involved in your pet’s care.

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Cute dog happily looking in the front camera

Complete the Form Below

Pet’s Name *

Owner's Name *

Owner's Email *

Age *

Species (dog, cat, etc.) *

Breed *

Color *

Procedure *

Checkboxes *

I the undersigned, certify that I am the owner, or authorized agent for the owner, of the animal described above.
I authorize the doctor on duty and assistants to perform the procedures listed above and on the attached estimate, including administration of pain medications, sedatives, and or anesthetics, as well as any necessary and appropriate medical, radiological, surgical, nursing, diagnostic, and or emergency care for the animal. I also understand that no guarantee of successful treatment can be made.
I have read and understand the reasons for and risks of the above and attached authorized procedure(s), and assume full financial responsibility for all charges and services incurred to the described animal.

Signature *

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Contact Information

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Primary Phone *

Name *

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Last

Secondary Phone

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Anesthesia Consent

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