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welcome.waggin@yahoo.com
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Home
About Us
Our Team
FAQs
Testimonials
Photo Gallery
Services
Cat-Friendly Care
Urgent & Emergency Care
Wellness & Preventative Care
Cryotherapy
View All Services
Resources
Payment Options
Emergency Clinic
Forms
New Client Form
Anesthesia Consent Form
Online Pharmacy
Careers
Contact
Appointment
Ayden, NC
Anesthesia Consent Form
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Pet Information
Pet's Name
*
Contact Information
circumstances. and I
Owner's Name
*
First
Last
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: (example: lump removal, exam, etc.)
*
Additional Services Desired While Patient Is Sedated
Please select any/all that you would like us to provide while your pet is sedated
Implant Microchip
Nail Trim
Clean Ears
Express Anal Glands
Sanitary Clip (rectum, genitals)
Remove Lumps (specify location of lumps below)
Other (specify below)
Please specify where the lumps are located
*
Please specify the additional service(s) you'd like provided to your pet
*
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, and 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 Welcome Waggin' 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 Welcome Waggin' Animal Hospital, the veterinarians, or any staff member liable for any complications that may arise.
*
I have read, understand, and authorize
Payment due upon services rendered.
*
I have read, understand, and agree.
I HAVE READ AND FULLY UNDERSTAND THIS ANESTHESIA CONSENT FORM
*
Yes
Signature of Responsible Party
*
Clear Signature
Date
*
Email
Submit
