Light Sedation Consent Form

Save time during your next appointment! Complete your required light sedation consent form from any device at any time before your visit.

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Online Form

Light Sedation Consent Form

Contact Information

Client's Name *

First

Last

Email *

Phone *

Additional Phone

Date *

Pet Information

Patient's Name *

Date of Birth *

Age *

Sex *

Species *

Breed *

Today's procedure is: (example: lump removal, exam, etc.) *

I am the owner or agent of the above described animal and hereby consent and authorize the following operation(s) and associated procedures to be performed:

Authorization

I understand that there are inherent risks involved with performing the above procedure(s) and/or maintaining a patient under sedation or general anesthesia, and I understand that unforeseen problems may arise which necessitate the extension and/or addition of the foregoing procedures or operations. I consent and authorize the staff at Chimney Rock Animal Hospital to perform any procedures or administer any drugs they deem necessary while under their care in order to keep my pet as healthy as possible. I understand that said procedures or drugs may incur an additional charge. *

I have read, understand, and authorize

I have been advised as to the nature of the procedures being performed and their associated risks. *

Yes

Signature of Responsible Party *

Clear Signature

Date *

Name

*This promotion is valid for new clients only and may be used once per client. Cannot be combined with other offers or promotions. Other restrictions may apply.

Chimney Rock Animal Hospital

Light Sedation Consent Form

Online Form

Light Sedation Consent Form

Contact Information

Pet Information

Authorization

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