Anesthesia Consent Form (Over 5 Years)
Complete your required forms online from any device at any time before your visit.
Consent For Anesthesia And Surgery (Over 5 Years Of Age)
Address Line 1
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District of Columbia
The doctor(s) and staff at Calhan Veterinary Clinic wish to provide the best care possible for your pet. Part of this care includes monitoring the function of your pet’s vital organs prior to administering any anesthetic agent, as well as administering pain medication. Our doctor feels that pre-anesthetic testing is necessary for your pet’s safety. Testing of the kidney and liver function, as well as hydration status, lets us know how well your pet will process the anesthetic agents we give him/her. Our doctor also feels strongly that pain management will better help your pet recover from surgery. We will be performing these procedures on your pet so that we can optimize the care we give your pet. These procedures are included in the estimate our doctor has provided you and include the following tests: Complete Blood Count (CBC) and Comprehensive Chemistry Profile.
Would you like our staff to discuss the benefits of these tests:
If declining, please initial here:
My pet has had the following medications in the last week:
The procedure(s) being performed today is/are
REASONABLE PRECAUTION WILL BE USED AGAINST INJURY, ESCAPE, OR DEATH OF YOUR PET. THE CLINIC AND STAFF WILL NOT BE HELD LIABLE FOR PROBLEMS THAT DEVELOP PROVIDED REASONABLE CARE AND PRECAUTIONS ARE FOLLOWED. I UNDERSTAND ANY PROBLEM THAT DEVELOPS WITH MY PET WILL BE TREATED AS DEEMED BEST BY THE STAFF AND VETERINARIAN(S) AND I ASSUME FULL RESPONSIBILITY FOR THE TREATMENT AND EXPENSE INVOLVED. I AGREE TO PAY FOR SERVICES RENDERED AT THE TIME THEY ARE COMPLETED. I WILL BE HELD RESPONSIBLE FOR REASONABLE COSTS INCURRED ON COLLECTION OF SAID FEES, SHOULD SUCH ACTION BE NECESSARY.
Please indicate if your pet requires any vaccinations or deworming: