Owner name* First Last Client ID*Animal Last Name*Breed*Age*Sex*Last meal eaten*Special diet or dietary restrictionsCurrent medications and time last administeredPlease list any known drug allergies or adverse reactions to medication(s)Procedure to be performed under sedation** I give my permission for my pet to be sedated for the above listed procedure.* I understand that in order for my pet to stay in the hospital they must be current on all vaccines and must have recent bloodwork to assess organ function.* I understand that even with excellent care and precautions, rare adverse reactions or events can occur with sedation. These events are extremely rare and can include but are not limited to: cardiac arrest, respiratory arrest, and death.* I understand that an IV catheter may be placed and a small area on the leg will be shaved for placementMICROCHIP: Would you like your pet to have a microchip placed while sedated? ($66.40 with surgery)*YesNoAlready have onePhone number where you can be reached between 8:30 a.m. and 3:30 p.m.*Please provide email address or cell number if you would also like an email or text update when your pet is awakeSignature*