Sedation Consent Form - Preston Animal Hospital : Preston Animal Hospital

Owner name*
First Last
Client ID*
Animal Last Name*
Breed*
Age*
Sex*
Last meal eaten*
Special diet or dietary restrictions
Current medications and time last administered
Please 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 placement
MICROCHIP: Would you like your pet to have a microchip placed while sedated? ($66.40 with surgery)*
- Yes
- No
- Already have one
Phone 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 awake
Signature*