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Sedation Consent

Date

Pet's Name

Client's Name

Procedure

Patient’s Medication/Supplements & Time of Last Dosage:

Medication

Last Given

Medication

Last Given

Sedation:

Certain painful procedures (minor mass removals, wound care, and laceration repair) can be done with sedation/reversal and sometimes a local nerve block. Other non-painful procedures can often require sedation due to anxiety to help protect the safety of our patients and staff. Your attending veterinarian may require an IV catheter to be placed for certain sedated procedures. Blood work and radiographs are not often required for these procedures. However, if you have questions or concerns you are encouraged to discuss them with the attending veterinarian before the procedure(s) is initiated.

Initial

Microchip Placement:

Collars break and tags become hard to read. Because a microchip will not “wear out”, it can be used to permanently identify your pet and link them back to you if lost or stolen. This is not a tracking device, just a permanent source of identification. The microchip must be registered, we will have you fill out a form and send in the registration for you.
Microchip Placement:
A
B
C

Consent/Authorization:

I understand that all reasonable care and precautions will be taken in performance of the procedures. I understand that with any anesthetic/sedation procedure, there are risks involved, including death, and I accept responsibility for those risks.
I understand the procedures to be performed and the risks involved. I also understand the doctors and staff may initiate life saving procedures in the event of an emergency.
I further understand that no guarantee of successful treatment is made. I certify that I have read and understand this release, and furthermore that I assume full financial responsibility for all charges related to the above procedures.

Signed Owner / Agent

Signature

Date