TREATMENT FOR ANESTHESIA RELEASE
Thank you for choosing us as your pet’s health care provider. Our intent is to give your pet the best possible care. We appreciate your patronage.
1. I am the owner of or authorized agent for the above pet and have the authority to execute this consent.
2. I hereby authorize Hampden Family Pet Hospital, P.C., it’s associated or designed assistants to perform the above procedures or operations and to administer anesthesia as needed.
3. I understand the nature and purpose of the procedure(s), risks involved, and possible complications that could arise. It has been explained to me and I understand that no guarantee can be made legally or ethically regarding any procedure(s) performed.
4. I understand the act of delivering intravenous sedation and inhalant anesthesia involves risks including, but not limited to adverse reaction (allergic reaction), infection and possible death. I consent to the use of such anesthetics as are considered necessary by the person(s) responsible for these services.
5. Your pet will also have an intravenous catheter placed before the procedure. This requires that a small amount of hair be shaved from your pet’s leg(s).
6. If deemed necessary the undersigned owner or guardian consents to resuscitative efforts (CPR) for the above pet.