Anesthesia Admission Form Anesthesia Admission FormOur caring staff members want to ensure your pet’s well-being. A veterinarian will perform a comprehensive physical exam before sedating your pet. However, many disorders of the kidneys, liver, heart, and blood can’t be detected without blood tests and a heart electrocardiogram (ECG). That’s why we will not anesthetize your pet without performing a presurgical screening before sedating your pet.Please enable JavaScript in your browser to complete this form.I understand that, in the event preanesthetic diagnostics reveal a health concern and indicate elective anesthetic procedures (dental cleaning, spay, neuter, etc.) should not be preformed at this time, the cost of these diagnostics will be due at time of discharge. *For all procedures: I understand that, although a thorough physical exam was preformed, there are cases where unexpected costs or needs (eg: overweight, in heat, additional anesthesia or supplies) may apply. **we build in a buffer on your estimate to help cover these cost, but on occasion more than the buffer may be neededFor dentals: I understand that, pets require sedation before a doctor can complete a thorough dental exam. Each tooth must be carefully evaluated so the veterinarian can determine the best treatment and that I or my representative must be available by phone today to discuss any additional procedures needed during this visit. *To save time OR in the event we cannot reach you, please choose from the options below *Preform any necessary procedures and extractions at this time. (Expected additional cost can range $200-$2000)Perform necessary procedures and extractions at an additional cost up to $500.Provide only the requested dental cleaning at this time.Anyone you would like to approve to make medical and financial decisions on your behalf today?You can reach me or my approved representative at *I understand that your hospital staff members use all reasonable precautions against injury, escape, or death of my pet. I further understand that sedation and anesthesia involves inherent risks to my pet and I will not hold your clinic liable in any manner whatsoever or under any circumstances in connection with the recommended procedure. I have read and completed this consent form and agree to assume all risks. **signature will also be required at time of procedureNameSubmit
