Anesthetic Consent Form

Anesthetic Consent Form

  • Your pet is scheduled for a procedure that requires anesthesia. Anesthesia inherently carries some risk. Before putting them under anesthesia, a veterinarian will perform a full comprehensive physical examination to identify any existing medical conditions that could complicate the procedure and compromise the health of your pet. There is always the possibility that a physical exam alone will not identify all of your pet’s health problems. The pre-anesthetic blood profile can be performed prior to anesthesia and results will be immediately available before general anesthesia and/or surgery which may help find any underlying medical problems. It is important to understand that a pre-anesthetic blood profile does not guarantee the absence of complications. It may, however, greatly reduce the risk of complications that could require medical treatment in the future. Would you like to have a baseline blood panel run if it is not already on the estimate?
  • I verify I am the owner (or authorized agent for the owner) of the above-named pet and authorize the above procedure to be performed. I authorize the use of anesthesia and other medication as deemed necessary by the veterinarian and understand that hospital personnel will be employed in the procedure(s) as directed by the veterinarian. Should any unforeseen procedures be necessary and indicated in the veterinarian’s professional judgment, please select one of the following options:
  • In the event of an emergency where I cannot be reached, I authorize life-saving measures to be performed.
  • MM slash DD slash YYYY
  • I fully understand that if an estimate is provided, it is an estimate only. Chena Veterinary Clinic makes every effort to remain within the estimate given. If you do not have an estimate and would like one please ask and it will be provided. All accounts are payable at the time of consultation. We accept cash, personal check, Visa, MasterCard, Discover, and Care Credit.