Sedation Consent Form

We recommend sedation for your pet to ensure their safety, comfort, and reduced stress during the procedure(s) listed above. Sedation involves administering medications to help your pet relax or sleep. While we take every precaution to minimize risk, all sedation carries some degree of risk, especially in pets with underlying health conditions.

Name

First Name

Last Name

Pet's Name

Pet's DOB

YYYY

Best Contact Number

for day of procedure

(###)

###

####

Secondary Contact Number

(###)

###

####

Procedure(s) requiring sedation:

for example: Exam, X-rays, Ultrasound

Have there been any changes to your pet's health since their last exam?

Please list all medications or supplements that your pet currently takes and when they were last given.

Does your pet have a microchip?

Yes

Do you want your pet to be microchipped while sedated today?

Yes

Already microchipped

Are there any other services your pet needs while sedated?

Anything else you would like to discuss at drop off?

I fully understand the procedure my pet is scheduled for.

Yes

In the unlikely event of an emergency, do you authorize the veterinary team to perform CPR and resuscitative efforts?

YES – I authorize life-saving efforts (including CPR and emergency medications if necessary)

NO – Do not perform resuscitative efforts if my pet stops breathing or their heart stops

Sedation Acknowledgement: I understand the nature of the sedation and why it is recommended. I understand that, although sedation is generally safe, there is a small risk of adverse reactions, including but not limited to respiratory or cardiac complications, prolonged recovery, or in rare cases, death. I authorize the attending veterinarian to administer sedation and any other necessary medical treatment during the procedure. I acknowledge that additional fees apply for sedation, monitoring, and any diagnostics or treatments performed. I understand that an IV catheter may be required and that in order for the IV catheter to be inserted the surrounding hair must be shaved to maintain sterility.

Date

YYYY