Anesthesia
Consent Form

Save time during your appointment. Complete the anesthesia consent form online from any device at any time before your visit.

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Anesthesia Consent Form

Contact Information

Owner Name *

First

Last

Email *

Home Phone *

Mobile Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Patient Information

Patient Name *

First

Last

Patient Age

Breed *

Sex

Male
Female

Color: *

Microchip Number

For the purpose of:

{Consult Presenting Problems}

Consent For General Anesthesia

Consent *

I am the Owner / Authorized agent of the pet described above. I consent for the patient described above to have anesthesia.

Consent *

The above contact information is accurate and I will be available by phone at all times today. Should I not be available when/if the doctor calls me for any reason, including but not limited to emergency care decisions, during said procedure I give consent for Her/Him to proceed and do what She/He feels medically necessary for the above listed patient and understand that I am authorizing further medically necessary treatments and the fees associated with them no matter the outcome.

Consent *

I agree to this procedure, the risks of the procedure have been explained to my satisfaction, and my questions regarding this procedure have been answered to my satisfaction.

Todays Date

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Anesthesia
Consent Form

Join the Pawsitive Wellness Family

Anesthesia Consent Form

Contact Information

Patient Information

Consent For General Anesthesia

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AnesthesiaConsent Form

Join the Pawsitive Wellness Family

Anesthesia Consent Form

Contact Information

Patient Information

Consent For General Anesthesia

Anesthesia
Consent Form