CHEW - Sedation Form

I certify that I am the legal owner of this pet and have full authority to provide all necessary information and make any decisions on behalf of my pet.*

Initial

Pet's Name*

First NameLast Name

Your Name*

First NameLast Name

Best phone number to reach you on procedure day *

Area CodePhone Number

Alternative Contact Phone

Area CodePhone Number

Date of sedation/procedure*

When was the last time your pet ate? How much did your pet eat? *

Has your pet ever experienced any adverse reactions during or after a sedated procedure in the past?*

YesNoUnsure

If yes, please describe/provide more information

Please list any medications, supplements, topical treatments your pet has received in the past 72 hours and when they were last given: If none have been given please state none.*

Is Your Pet Current On Vaccinations - Proof of Vaccines will be required?*

YesNoI Am Not Sure

Does Your Pet Have A Microchip?*

YesNoNo, microchip while sedated

Does Your Pet Have Known Health Concerns and/or Chronic Disease or Conditions?*

If yes, please tell us more. If no, please note N/A

Is There Anything Else We Should Know About Your Pet?

If yes, please tell us more. If no, please note N/A

I acknowledge that my pet will be sedated for the following medical procedure. Please be specific and detailed about the procedure, including body part involved (e.g., head/neck/ear/leg/paw/front/back/left/right). If you are unsure, contact our office for clarification before completing this form. This information is crucial for ensuring clear communication and mutual understanding between both parties.*

While my pet is sedated, I request the following add-ons to be performed. These will be added to your final invoice:

i.e: nail trim, anal glands, ear cleaning

If your pet becomes nauseous, do you give CHEW permission to give an anti-nausea medication (cerenia) siren*

I hereby authorize the sedation of my pet at CHEW Animal Clinic today and confirm that I understand the nature and details of the procedure. *

In the event of an unforeseen emergency, we will make every effort to contact you promptly. Please be assured that we take all necessary precautions to ensure your pet is safe and in good health before proceeding with their scheduled procedure. Any known risks will be thoroughly discussed with you in advance. However, on rare occasions, emergencies can occur, and we ask that you indicate your preference in the event that we are unable to reach you. Please select your preference below:*

Please proceed with basic cardiopulmonary resuscitation (CPR). I accept responsibility for all costs incurred (starting at $175).Please do not proceed with basic cardiopulmonary resuscitation (CPR). I accept responsibility for all costs incurred.

Your pet will undergo sedation using an injectable medication to allow a short procedure to be performed safely and pain-free. The effects of sedation may take several hours to fully wear off and, in some cases—especially in older patients—may last longer. Mild drowsiness may be expected for 24–48 hours following sedation.

What You May Expect After Sedation

Grogginess / Incoordination: Your pet may appear sleepy, unsteady, or mildly disoriented for 12–24 hours following sedation. Sleeping on and off during this time is normal, and your pet may appear wobbly or unbalanced. We recommend keeping your pet confined to a small, safe area and avoiding stairs or steps until they are fully alert.
Nausea: Mild nausea may occur after sedation. Once home, your pet should have access to water but should not be allowed to drink large amounts at once, as this may cause vomiting. If your pet is able to keep water down for one hour, a small amount of food may be offered. Normal eating and drinking should return within 12–24 hours.

Feeding Instructions
A small amount of food and water should be offered the evening of the procedure, as your pet may still be groggy. If your pet appears more alert the following morning and has not vomited, their normal feeding routine may be resumed.

Medications
If medications are prescribed, they should be given exactly as directed on the prescription label. Unless otherwise instructed, medications may be started the morning after the procedure with a full meal.

When to Contact CHEW or Urgent Care:

Vomiting lasting longer than 24 hours after the procedure
Lethargy or depression lasting more than 24 hours
Loss of appetite for more than 48 hours
Diarrhea
Bleeding