Anesthesia / Surgery Consent Form

Please note: this form is for demonstration purposes only, no pet care is available from this site.

"*" indicates required fields

Pet Name:*

Client Name:*

First Last

Phone*

Email*

Your pet will be undergoing general anesthesia plus a surgical procedure today. In order to recognize any underlying abnormalities your pet may have, we have already performed a complete blood profile.

We require placement of an IV catheter to administer fluids while under anesthesia. IV fluids will aid the body in stabilizing internal organs, stabilizing blood pressure, and flushing the anesthesia out of the body more efficiently. Along with shaving the hair at the IV catheter site, we may also shave other areas including the surgical site for surgical prepping and cleansing, and also the monitor sites, so they will function properly.

I UNDERSTAND*

I understand that some risks always exist with anesthetic procedures, and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before these procedures are initiated. Should some unexpected life-saving emergency care be required and the attending veterinarian be unable to reach me, the staff has my permission to provide such treatment, and I agree to pay for such care.

I AGREE*

I agree to indemnify and hold Cheshire Animal Hospital harmless from and against any and all liability arising out of the performance of any of the procedures referred to above.

What phone number(s) can you be reached at today:*

Are there any times you will be unavailable?:*

Can you be reached by text if we can't reach you by phone?*

YES

Number to text:

Entering Your Full Name Here Will Serve As Your Digital Signature:

Digital Signature:*

Signature

Date*

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