Anesthesia Consent Form

Save time at your pet’s procedure! Complete your required anesthesia consent form online from any device at any time before your visit.

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Anesthesia Consent Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Client: *

Patient: *

Sex: *

Date:

DOB:

Species: *

Phone: *

Email *

Age: *

Breed: *

Anesthesia and Surgical Consent Form

River's Edge Pet Medical Center is dedicated to upholding the highest standards of veterinary medicine possible. Thank you for entrusting your pet's care to our experienced and knowledgeable staff.

Anesthesia and procedure(s) to be performed:

Authorization and Risk Assessment *

I authorize anesthesia and/or surgery for my pet. The nature and risks of this procedure have been explained to me. I understand that some risks always exist with anesthesia and/or surgery, and I am encouraged to discuss any concerns I have with my veterinarian before the procedure(s) are initiated. No warranty or guarantee has been given to me as to the results of these treatments or procedures. My signature on this consent form indicates I fully understand these risks and that any questions have been answered to my satisfaction
I will not hold River's Edge Pet Medical Center, the veterinarians, or any staff member liable for any complications that may arise.

In the event of spontaneous arrest (heart rate, breathing, etc.), I elect the following (please select one):

CPR - Cardiopulmonary resuscitation (CPR) of a collapsed or unconscious patient is tailored to meet the needs of the individual, including but not limited to: IV catheter placement, IV fluids, emergency injectable medications, intubation and artificial ventilation, or chest compressions. (Estimated, but not limited to, $500 minimum)
DNR - DNR “do not resuscitate”, this means that in the event of cardiac arrest, CPR will NOT be performed if the patient stops breathing, enters cardiac arrest, collapses, and/or becomes unconscious.

Animals that have survived cardiopulmonary arrest and have been successfully resuscitated (CPR) are extremely critical and unstable. Management of the post-arrest patient requires vigilant monitoring and the technical expertise of dedicated critical care personnel. This care is costly and the outcome is uncertain.

I HAVE READ AND FULLY UNDERSTAND THIS SURGERY AND ANESTHESIA CONSENT FORM.

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Anesthesia Consent Form

Anesthesia Consent Form

Anesthesia and Surgical Consent Form

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