Anesthesia Consent Form

Welcome to Laurel Road Veterinary Clinic. We’re glad you’re here. This Anesthesia Consent Form helps our team get to know you and your pet before your first visit so we can provide personalized, efficient care from the moment you arrive.

Get Started

Anesthesia Consent Form

Date(Required)

Owner’s Name(Required)

First Last

Pet’s Name(Required)

Phone(Required)

Email(Required)

What procedure is your pet having done today?(Required)

If your pet is having mass removed, please indicate where on the body the mass(es) are located(Required)

Current Medication(Required)

When was the last time your pet ate?(Required)

Would you like the doctor to microchip your pet during the procedure?(Required)

Yes

No

Would you like the doctor to trim your pet’s nails during the procedure?(Required)

Yes

No

If nails are done during the procedure, there is NO Charge.

I hereby certify that I am the owner or duly authorized agent for the owner, of the animal described above. I understand that any anesthesia involves some risk to my pet. I will discuss any questions or concerns that I may have with my veterinarian before the procedure. I grant consent for anesthesia and this procedure and agree to pay in full services are rendered.(Required)

I Accept

I Decline

I hereby authorize Laurel Road Veterinary Clinic and its designated associates or assistants to administer such treatments and perform such procedures, including anesthesia, as are considered therapeutically and/or diagnostically necessary for the care of my animal.(Required)

I Accept

I Decline

A pre-surgical ECG may at times indicate a potential abnormality of the heart. If this is noted on the specialist report, x-rays of the chest are recommended before proceeding with anesthesia.(Required)

Call Before Taking X-Rays

X-Ray without calling

Dental Extractions and Additional Treatment

I authorize the veterinarian to perform any necessary tooth extractions and related treatments deemed medically necessary(Required)

I Accept

I Decline

Maximum amount authorized without additional contact: $(Required)

Please contact me before performing any extractions or treatments that increase the estimate.

I understand, that if an emergency treatment is required, and I cannot be reached, I authorize the veterinarian(s) and assistants to perform such medical treatment as is necessary to preserve the life of the patient (CPR), until I can be contacted for further authorization. I understand that no guarantee of successful treatment is made or implied. I hereby release the veterinarians and assistants from all claims, except claims for negligence, arising out of or connected with the performance of his/her treatment.(Required)

I Accept

I Decline

Signature(Required)

Date(Required)

Ready to Get Started?

Become part of the Laurel Road Veterinary Clinic family today. Complete and submit the New Client Form below, and we’ll be in touch to welcome you to our Nokomis, FL, veterinary practice and help you schedule your pet’s first visit.

Anesthesia Consent Form

Anesthesia Consent Form

Ready to Get Started?

Book your pet’s visit today

Contact Us

Location

Hours

Have a question?