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)Ultrasound to be performed*(NOTE: Any pet undergoing an ultrasound may be shaved at the corresponding site.)SEDATION AND ADDITIONAL PROCEDURES: Sedation may be required to complete your pet’s ultrasound or may be required if needle aspirates of certain tissues are necessary. Please choose one*I authorize Gentle Care Animal Hospital to administer sedation and any needle aspirates that are deemed necessary.I authorize Gentle Care Animal Hospital to administer sedation but wish to be called if needle aspirates are deemed necessary.I wish to be called prior to my pet receiving any sedation.* I understand that if I cannot be reached by phone within 5 minutes I will have to schedule the recommended procedure or ultrasound for another time.* 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.* understand that if sedation is needed 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)*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*