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Anesthesia/Surgery Consent Form

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Anesthesia/Surgery Consent Form

  • Date Format: MM slash DD slash YYYY
  • Your pet will be undergoing general anesthesia plus a surgical procedure today. Please review the consent and do not hesitate to inform us of any questions or concerns you may have.

  • Pre Anesthetic Blood Work

  • Authorization and Risk Assessment. Please initial after each statement below

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  • (initial here)
  • (initial here)
  • (initial here)
  • Consent for CPR or DNR:

    In the case that your pet were to suffer cardiac and/or pulmonary arrest (heart or breathing stops), do you authorize us to provide Life-saving measures (i.e. cardiopulmonary resuscitation)? Costs of these services can be $500 and are NOT reflected in this estimate. If you choose to allow these procedures for your pet, you will be contacted as soon as possible to be informed of the situation and given the options how to proceed.
  • (Owner/Authorized Agent Signature )
  • Date Format: MM slash DD slash YYYY