Please Note: We will be closing early on Tuesday, December 24th at 1 PM and closed on Wednesday, December 25th in observance of Christmas!

Sedation Consent Form

get started

We look forward to treating your pet.

Thank you for entrusting us with the safety and health of your pet.

Sedation Consent Form

Please fill out the following form before your pet’s procedure. If you have any questions, please contact us. Please Note: All * fields are required.

Owner's Name *

First

Last

Pet's Name *

Email *

Phone *

Additional Phone

Secondary Contact: *

First

Last

* This person has your authority to consent to medical decisions regarding your pet's surgical care in the event we cannot reach you.

Secondary Contact Phone *

Today's procedure is (examples include wound, limp, X-rays, exam, etc.): *

Authorization

I authorize anesthesia/sedation for my pet. The nature and risks of this procedure have been explained to me. I understand some risks always exist with anesthesia and/or sedation. I am encouraged to discuss any concerns I have about those risks with my veterinarian before the procedure(s) are initiated. My signature on this consent form indicates that any questions have been answered to my satisfaction. *

I have read, understand, and authorize.

I authorize Yorkshire Animal Hospital to perform any additional diagnostic, treatment, or surgical procedure(s) deemed necessary for medical complications or otherwise unforeseen circumstances. I understand there are rare complications associated with any anesthetic procedure. No warranty or guarantee has been given to me as to the results or cure afforded by these treatments or procedures. I fully understand these risks and understand the veterinarians and hospital staff will try to minimize such risks. I will not hold Yorkshire Animal Hospital, the veterinarians, or any staff member liable for any complications that may arise. *

I have read, understand, and authorize.

Payment is due upon services rendered. *

I have read, understand, and agree.

Date *

Comment

Sedation Consent Form

We look forward to treating your pet.

Sedation Consent Form

Authorization

Yorkshire Animal Hospital

Contact

Hours

Location

Download our app and connect with us on PetDesk!

Have a question?