Anesthetic Consent Form

  • Date Format: MM slash DD slash YYYY
  • I, the undersigned owner, authorized agent of the owner or Good Samaritan responsible for seeking veterinary care for the pet identified above, certify that I am over eighteen years of age, and hereby authorize the veterinarian(s) at this practice to perform the above noted procedure(s). I understand that some risks always exist with anaesthesia and/or surgery and I am encouraged to discuss any concerns I have about those risks with the attending veterinarian or veterinary technician before the procedure(s) is/are initiated. My signature on this form indicates that any questions I have regarding the following issues have been answered to my satisfaction:

    1. The medical and/or surgical treatment alternatives for your pet.
    2. Sufficient details of the procedures to be performed on your pet.
    3. How your pet might respond to treatment and possible recovery time.
    4. The most common and serious complications.
    5. The length and type of follow-up restraint and care required.
    6. The estimate of the fees for all services rendered.

    While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that veterinary medicine is an inexact science and that no guarantee or warranty has been made regarding the results that may be achieved. I also understand that laser may be used in the procedures noted above.

    Should some unexpected life-saving emergency care be required and the attending veterinarian is unable to reach me, this hospital’s staff has my permission to provide such treatment and I agree to pay for all related fees.

    If your pet is undergoing an anaesthetic procedure, rest assured that advances in anaesthesia, anaesthetic monitoring, and surgery have made procedures safer with a low rate of complications. The most common complications may include but are not limited to infection, swelling and intestinal upset. Extremely rare and serious anaesthetic complications including death can also occur.

    If the animal is not claimed by the owner within 10 days of completion of an in-hospital treatment and convalescence, it is deemed to be abandoned and I hereby consent that the veterinarian may dispose of the live animal by transferring the animal to an animal shelter or to a third party owner if:

    1) the client has agreed in writing to the transfer
    2) the veterinarian has attempted to contact the client at least five times by at least two different methods, such as telephone and mail and has documented these attempts
    3) the veterinarian has attempted to contact any emergency person identified by the client
  • E-Signature