Anesthesia Consent Form

Name

First Name

Last Name

Patient Name

Procedure Being Performed

Electronically Signed (Please type full name)

Future Consent

Check here if you wish to keep form on file and use for ALL future anesthetic procedures for this patient

By signing the form above, I attest that:

I am the owner or authorized agent for the above animal and have authority to execute consent for the surgical/medical procedure. The reasons why this operation/procedure is being performed, its advantages, possible complications, and possible alternative modes of treatment have been discussed with me. With full understanding of the above, I authorize the attending veterinarian to perform, under anesthetic deemed advisable and/or available, said operation/procedure. I understand that further procedures may be therapeutically necessary based on findings during the operation/procedure. I consent to those procedures, their additional cost, and any unexpected lifesaving emergency care deemed necessary by the attending veterinarian.

I understand that risks and potential complications exist with anesthesia and surgery. These include, but are not limited to: abnormal reaction to anesthetic agents, self-inflicted injury during anesthesia recovery (i.e. fractured legs, head trauma), muscle and nerve damage, dehiscence of incision, colic, post-operative infection, equipment failure, and death.

I acknowledge and understand that the procedure, its consequences, and subsequent risks have been explained to me, and I have addressed any questions or concerns I may have. I also realize that results cannot be guaranteed.