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Anesthesia/Sedation/Surgical Consent Waiver
Fill out the form with your pet’s information.
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Please Initial After Each Statement:
I hereby authorize East & West Animal Hospital to perform anesthesia/sedation/surgery for my pet. The nature and risks of this procedure have been explained to me. I understand that some risks exist with anesthesia and or surgery and am encouraged to discuss any concerns associated with risks with the veterinarian before the procedure(s) are started. I will not hold East & West Animal Hospital, the veterinarian, or any team member liable for any unforeseen complications that may arise.
Please Initial
I hereby authorize East & West Animal Hospital to perform any additional diagnostics, treatment or surgical procedure(s) deemed necessary for medical and surgical complications or any unforeseen circumstances. While East & West Animal Hospital provides the highest quality of anesthesia monitoring and surgical services, I understand that the veterinarian and hospital team will do everything possible to reduce any risks. I will not hold East & West Animal Hospital, the veterinarian, or any team member liable for any unforeseen complications that may arise.
Please Initial
Please Initial confirming you read and agree with the above information
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Pre-Anesthetic Bloodwork
- Our on-site laboratory lets us screen for hidden problems before your pet’s treatment begins. These tests also provide a baseline for monitoring your pet during surgery, and can indicate chemical imbalances that could affect the pet under anesthesia.
Monitoring
– Your pet’s blood pressure, temperature, heart rate and rhythm, respirations, and oxygen levels are closely monitored using state-of-the-art equipment. We use a range of techniques and equipment to help maintain your pet’s body temperature while under anesthesia.
Intravenous Catheter with Fluids
– Administration of intravenous fluids helps the patient recover more quickly from anesthesia, maintains blood pressure, and increases circulation during anesthesia. The intravenous catheter is also used to administer medication if needed.
Pre-Anesthetic Bloodwork - $70.00
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I decline
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Full Blood Panel - $170.00
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Client Name
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Pet Name
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Contact Number
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Signature
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Date
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Email Consent
I agree to receive recurring automated messages about pet care, appointment reminders, marketing communications, and offers to the mobile number provided. Your consent is not required, and you may opt out at any time by replying STOP. Msg & data rates may apply. Message frequency may vary.
I agree to receive email communications.
SMS Consent
I agree to receive recurring automated messages about pet care, appointment reminders, marketing communications, and offers to the mobile number provided. Your consent is not required, and you may opt out at any time by replying STOP. Msg & data rates may apply. Message frequency may vary.
I agree to receive SMS communications.
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