Anesthesia & Sedation Form

Pinehurst Animal Hospital & Dental Clinic Anestesia/Sedation Consent Form

Our greatest concern is the wellbeing of your pet, and a physical exam will be performed by the attending veterinarian before anesthesia. However, Some conditions can exist without clinical illness that may affect how you pet responds to anesthesia. Many conditions, including disorders of the kidneys, liver, or blood are not detectable with routine exams, and can only be detected if blood testing is performed. Such tests are especially important befor any kind of procedure involving sedation/anesthesia. This is not because sedation/anesthesia is unsafe, but because an underlying condition could be exacerbated during or after anesthesia. If a problem is detected, an adjustment in the anesthesia protocol may be made, or the procedure may be delayed until the problem is addressed.

For these reasons we include blood screening before any procedures involving anesthesia are performed. The screening consists of a Chemistry Panel to check for disorders of the liver, kidneys, blood sugar, protein level and other disease processes and a Complete Blood Count (CBC) to check the levels of the red blood cells, white blood cells and platelets. The cost of these important blood tests is $108.00.

Decline Bloodwork
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Appointment Date

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Date
The reasons why this procedure is necessary, its advantages, possible complications, and possible alternative modes of treatment have been discussed with me. I understand that risks and potential complications exist with anesthesia and surgery, and I have been informed of those risks, and specific complications for this particular procedure. I further understand that the course of operations or procedures, unforeseen conditions may arise that may necessitate the performance of additional procedures, including CPR (life-saving measures). I understand that these measures may have an associated costs and/or risks. I understand that I will be financially responsible for all services rendered to and for my pet.

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Phone number where you can be reached today
Pet's Name

Pet's NameOwner's Last Name
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