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Sedation Consent Form
Pet Name
*
Client Name:
*
Contact number for today:
*
Email:
*
Preferred method of contact: (select one)
*
Preferred method of contact: (select one)
A
Call
B
Text
Last time my pet ate:
*
Last time my pet went to the bathroom:
*
Untitled multiple choice field
A
Urine
*
B
BM
C
Both
I, the undersigned owner, of the pet identified above, authorize Austin Urban Vet Center to sedate my pet for the following procedure:
*
Signature
*
Austin Urban Vet Center recommends pre-sedative bloodwork before any sedative procedure. This is to help minimize risks during sedation by evaluating the status of your pet's major organ systems.
I authorize Austin Urban Vet Center to perform pre-sedative bloodwork.
*
I authorize Austin Urban Vet Center to perform pre-sedative bloodwork.
A
Yes
B
No
I hereby authorize/sedation for my pet. I understand that some risks always exist with anesthesia/sedation and that rare complications may arise, including anesthetic death.
I have read and understand the above statement.
Please Initial:
*
Signature
Full payment is expected at time services is rendered. I understand the risks associated with procedures performed at Austin Urban Vet Center.
Signature:
*
Signature
Date:
*
Submit
