Anesthesia Consent Form

Major Procedures and Dental Procedures

Complete this form before your visit.

Pet Information

As with any procedure requiring general and/or local anesthesia, there are certain risks that serious complications or even death may result. To minimize the risk of such occurrences, we mandate baseline blood work be performed in order to assure proper organ function, clotting ability, detect anemia or infection. This also gives us baseline values for future reference.

As the owner of the above pet, I certify that I am over the age of 18; and I authorize the staff of this hospital to perform the procedure(s) listed above, as well as those deemed necessary to treat life-threatening emergencies. As with all anesthetic, treatment, and/or surgical procedures, I understand there are risks inherent in these services. I acknowledge that staff members at this practice have explained the procedures to me, answered questions to my satisfaction, and cannot be held responsible for any unforeseeable results. Further, I understand that I am financially responsible for all costs incurred during this surgery, treatment, and hospitalization, and all costs associated with any complications that may arise. 

While I accept that all procedures will be performed to the best of the abilities of the staff at this facility, I understand that veterinary medicine is not an exact science and that no guarantees have been made regarding the outcome of this/these procedures. I have read and understand the nature of the above procedures and accept the specific terms and conditions set forth herein.

The doctor and staff of this facility will attempt to provide reasonable precautions against injury, escape, and/or death of each patient evaluated, admitted, and/or treated at Highlands Pet Hospital. However, the doctor and staff will not be held liable or responsible in any manner, or under any circumstances, on the account of the services rendered including treatments, surgery, safekeeping, or any and all other services administered or offered to this patient, or otherwise in connection therewith. I understand that I assume all risk.

Furthermore, I understand that Highlands Pet Hospital is not staffed 24 hrs a day and staff are not continuously present to observe or monitor patients after regular business hours. Should my pet's condition warrant it, the doctor may advise (or require) the transfer of my pet to an after-hours emergency clinic or 24-hour hospital. I understand that I may request the transfer of my pet for after-hours care as well.

I understand that estimates are only an estimation of fees and actual charges may be more or less than a prepared estimate indicates. I also understand that estimates do not include medications. 

I acknowledge that I am responsible for payment in full for the above procedures and treatments at the time my pet is discharged. I further understand that future care for this or other needs will be charged for separately.