Sedation Consent Form
Last meal eaten
Special diet or dietary restrictions
Current medications and time last administered
Please list any known drug allergies or adverse reactions to medication(s)
Procedure to be performed under sedation
Please accept the following
I give my permission for my pet to be sedated for the above listed procedure.
I understand that in order for my pet to stay in the hospital they must be current on all vaccines and must have recent bloodwork to assess organ function.
I understand that even with excellent care and precautions, rare adverse reactions or events can occur with sedation. These events are extremely rare and can include but are not limited to: cardiac arrest, respiratory arrest, and death.
I understand that an IV catheter may be placed and a small area on the leg will be shaved for placement
MICROCHIP: Would you like your pet to have a microchip placed while sedated? ($66.40 with surgery)
Already Have One
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: