Sedation Release Authorization - Redwood Veterinary Hospital Inc.

Sedation Release Authorization to Perform Medical Procedure

All fields with * are required and must be filled.
Pet Owner*

First NameLast Name
Pet's Name*
To perform the recommended medical procedure your pet’s doctor has recommended sedation/tranquilization for your pet so that the procedure can be done properly, safely, and with little or no discomfort.

Sedating a pet is generally considered to be very safe. Nonetheless, each animal responds differently to sedative medications, it is possible that additional medications may be needed to deepen the sedative level or lengthen the sedative period so we can complete the planned procedure safely. Because this “extended sedation” would require additional medications and monitoring, additional costs may result. Your estimate should reflect this possible additional cost.
By signing below, I acknowledge that I am the owner, or agent of the owner, of the animal named above. I understand the risks associated with sedative medications are low, but I also understand that any medical procedure carries some risk. I authorize the doctor to proceed with the sedation and the medical procedure as discussed.
Signature*
Date*

MonthDayYear
Date
Phone number where you can be reached while your pet is in the hospital*
Please enter a valid phone number.Format: (000) 000-0000.
Should be Empty:

Sedation Release Authorization to Perform Medical Procedure