Sedation Consent Form
Owner Name
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First Name
Last Name
Client ID
Animal Name
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Breed
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Age
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Sex
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Last meal eaten
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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
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Please accept the following
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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)
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Yes
No
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
Signature
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