SEDATION CONSENT FORM

You can submit our “Sedation Consent Form” in two ways:

1) Fill out and print our Sedation Consent Form here. You must bring the form printed and filled out on your next visit.

2) Fill out our form online:

Sedation Consent Form

"*" indicates required fields

Pet's Name *

Name *

First

Last

Phone *

Email *

I hereby certify that I am the owner of the above-named animal or am responsible for it and have the authority to execute this consent.

Procedure 1 *

Procedure 2

Procedure 3

Procedure 4

I hereby also authorize the use of such anesthetics as you deem advisable and performance of such surgical or therapeutic procedures as you determine to be indicated.

IV Catheter Placement and Preparation *

I understand that for the safety and well-being of my pet, one or more of their legs will be shaved to allow for sterile placement of an intravenous catheter. This is a standard and necessary part of surgical preparation and patient care. I acknowledge and consent to the shaving of my pet’s leg(s) for IV catheter placement.

I agree to indemnify and hold Cascade Summit Animal Hospital harmless from and against any and all liability arising out of the performance of any of the procedures referred to above.

What phone number can you be reached at today?

Are there any times you will be unavailable? *

Can you be reached by text if we can't reach you by phone?

Phone Number to Text

Signature *

Clear Signature

Date *

Phone