Ultrasound/Sedation Consent Form
Last Meal Eaten
Special Diet or Dietary Restrictions
Current Medication and Time Last Administered
Please list any known drug allergies or adverse reactions to medication(s)
Ultrasound to be performed under sedation
(Please note - any pet undergoing sedation may be shaved at the corresponding site.)
SEDATION AND ADDITIONAL PROCEDURES: Sedation may be required to complete your pet’s ultrasound or may be required if needle aspirates of certain tissues are necessary.
I authorize Gentle Care Animal Hospital to administer sedation and any needle aspirates that are deemed necessary.
I authorize Gentle Care Animal Hospital to administer sedation but wish to be called if needle aspirates are deemed necessary.
I wish to be called prior to my pet receiving any sedation.
Please select all below
MICROCHIP: Would you like your pet to have a microchip placed while sedated? ($66.40 with surgery)
Phone number where you can be reached between 8:30 a.m. and 3:30 p.m.
Please provide email address or cell number if you would also like an email or text update when your pet is awake
Should be Empty: