Anesthesia Release Form

AUTHORIZATION AND CONSENT FOR HOSPITALIZATION/SURGERY

I am the owner or agent for the below animal and have the authority to execute this consent and authorization of the following procedure/care:

I understand that during the performance of procedures for the above situation (s), unforeseen conditions may be revealed that necessitate an extension of the foregoing procedures, or even procedures different from those set forth previously. I hereby consent and authorize the performance of such procedures as necessary and desirable in the exercise of the veterinarian’s professional judgment. I have been advised of the nature of the services and procedures, as well as the risks involved, and I also realize that results cannot be guaranteed.

I additionally authorize the use of appropriate anesthetics, pathologist examination of excised tissue(s) deemed appropriate by the veterinarian, and the administration of other medications, and understand that hospital staff will be utilized as deemed necessary by the veterinarian. I have read and understand this authorization and consent.

DOES YOUR PET TAKE ANTI-INFLAMMATORIES (i.e. gabapentin, vetprofen, meloxicam, prednisolone?)(Required)
HAS YOUR PET HAD A RECENT (WITHIN 2 WEEKS) STEROID INJECTION?(Required)
While hospitalized, if your pet suffers respiratory arrest (stops breathing) or cardiac arrest (the heart stops), we need to know your wishes concerning treatment. Would you like us to resuscitate your pet?(Required)
MM slash DD slash YYYY
Consent(Required)

*****Please note, the phone number you provide on this form is the number we will be using to contact you while your pet is here. It is vitally important that you are reachable by phone******