Hospital Sedation/Anesthesia Consent

Owner Details

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Last Name

Pet Details

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Breed

Age

Sex

Male

Female

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Sedation and general anesthesia:
I understand that some risks always exist with anesthesia and/or surgery and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure is initiated. I accept that veterinary medicine is an inexact science and that no guarantee of successful treatment has been made. While all types of anesthesia involve some risk, major side effects and complications are rare. Some risks are related to and may increase in frequency depending on the pets’ overall health, age and their unique responses to anesthetic drugs. Complications of anesthesia include but are not limited to: unexpected drug reactions, corneal ulcerations, tracheal injury, esophagitis, blood clot formation, lung injury and death.

Pre-Anesthetic Testing
Our greatest concern is the well being of your pet. We will monitor your pet’s vital signs very closely during surgery. This along with pre-anesthetic blood screening reduces many of the risks of surgery.
Pre-anesthetic testing provides a more complete picture of your pet’s overall health by assessing for otherwise hidden but potentially significant health issues, and helps minimize unexpected short and long term complications.

Pre-anesthetic bloodwork is recommended for all patients undergoing anesthesia.

I approve the recommended pre-anesthetic testing

I decline the recommended pre-anesthetic testing

Date

Signature of owner

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Financial responsibility
I understand that an estimate of the costs for veterinary services will be provided to me and that I am encouraged to discuss all fees related to such care before services are rendered and during this pet’s ongoing medical treatment.
I understand that I am responsible for all costs associated with the above approved procedure. I understand that payments are due at the time of service.

Procedure authorization
My veterinarian has explained to me that while a satisfactory result is expected, all operations and procedures carry a risk of unsuccessful results, complications, injury or even death, from both known and unforeseen causes.
I understand that there is no certainty that my pet will achieve all of the expected operation or procedure benefits and no guarantee has been made regarding outcome. I have been informed of the following: • The nature and purpose of the operation or procedure, including related care, treatment and medications. • The potential benefits, risks or side effects of the operation or procedure and its recovery period • The likelihood of achieving the treatment goals • Reasonable alternatives and their relevant risks, benefits and side effects • The possible outcomes related to not receiving care or treatment. • The possibility of incurring additional costs as a result of any complications

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The Care Plan has been clearly explained to me by a doctor or staff member. Major risks of any surgery/procedure to be performed have been discussed with me by my doctor or a member of the staff.

I understand that unforeseen complications and/or changes in my pet’s status may occur during the hospital stay or after discharge. These complications or unexpected conditions may alter the Care Plan and will be discussed with me by my doctor or staff

Updates on my pet’s status and Care Plan will be provided to me following the procedure/surgery. I will be notified promptly of any significant changes in my pet’s condition.

I authorize that I am the decision maker for this pet and authorize the above procedure.