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:

"*" indicates required fields

Pet 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.*

I DO

I hereby authorize the performance of the following procedure(s):

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.*

I DO

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.*

I DO

What phone number(s) 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?*

YES

Number to text:

Entering Your Full Name Here Will Serve As Your Digital Signature:*

Date*

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Comments

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Sedation Consent Form

I hereby authorize the performance of the following procedure(s):

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