Sedation Consent Form

Name: Veterinarian
Brand: Blue Oasis Pet Hospital

Client Information

Client Name:

First

Last

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Phone Number:

Email Address:

Patient Information

Patient Name:

Species:

Breed:

Sex:

Color:

Weight:

Procedure(s) to be performed:

I, the undersigned owner or agent of the pet identified above, authorize the veterinarian and staff of Blue Oasis Pet Hospital to perform the above procedure(s).

I understand that some risks always exist with sedation and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure(s) is/are initiated

I understand that the attending veterinarian will make every effort to contact me regarding treatment in the case of unforeseen emergencies. If unable to contact me, the staff may or may not have my permission to proceed with life sustaining procedures.

Yes, I give my permission

No, I do not give my permission. DNR

While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I

understand that no guarantee or warranty has been made regarding the results that may be achieved.

I also assume full responsibility for any additional expenses incurred after the procedure is performed, such as follow up radiographs, re-check physical exams and complications. These are more likely to occur when there is a failure to comply with the aftercare instructions.

I have read and fully understand the terms and conditions set forth above.

Phone number(s) at which at which owner can be reached on day of procedure:

Signature of Owner

Sign above

Sedation Consent Form

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