Surgery & Anesthesia Consent Form

Your Name (required)

Your Email (required)

Todays Date (required)

Pets Name:

I certify that I am the owner of this pet and that I am over the age of eighteen (18).

I authorize general anesthesia, sedation and / or surgery for my pet. While Abby Pet Hospital provides a high quality of anesthesia monitoring and surgical services, I understand that there are rare complications associated with any anesthetic or surgical procedure. The inherent risks of this procedure have been explained to me. I understand that some risks always exist with anesthesia / sedation and surgery, and I have discussed any concerns about those risks with my veterinarian before the procedure(s) are initiated. My signature on this consent form indicates that any questions have been answered to my satisfaction.

In the event of an emergency, I authorize Abby Pet Hospital to perform any additional diagnostics, treatment or surgical procedure(s) deemed necessary for my pet.

In the event of cardiac arrest, (CHOOSE ONE)

I DO NOT request resuscitation be performed on my pet

I DO request closed chest resuscitation be performed on my pet

I DO request open chest resuscitation be performed on my pet

I HAVE READ AND FULLY UNDERSTAND THIS SURGERY AND ANESTHESIA CONSENT FORM and know that the veterinarians and hospital staff will try to minimize such risks. I will not hold Abby Pet Hospital, the veterinarians, or any staff member liable for any complications that may arise.

I have not given my pet any food after 10pm on the night before the procedure, unless otherwise advised by my doctor. I understand that this is important for anesthesia safety.

Signature:

Date

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