Sedation consent form

Name

First Name

Last Name

Patient Name

Purpose of Sedation

Electronically Signed (Please type full name)

Future Consent

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

Sometimes, sedation is required to adequately facilitate an exam and/or procedure on your animal(s). Risk factors with sedation include, but are not limited to: abnormal and/or allergic reaction to sedation, sudden changes and/or decrease in cardiovascular or respiratory function, inadvertent drug administration into artery, slowed/decreased gastrointestinal motility, injury due to incoordination, and rarely cardiovascular or respiratory arrest, and death.

By signing the form above, I attest to the following statements:

I understand the risks involved with sedation, as stated above.

I understand the every reasonable effort will be made to avoid these risks, and to medically intervene should one of these potential complications occur.

I understand that further medical intervention may be required that is beyond the scope of the attending veterianarian, such as referral to a specialty hospital for ongoing care.

I will not hold Aggie Vet and Farrier Services, LLC, or any of its employees, financially or professionally liable for medical complications related to sedation, including but not limited to death of the animal.