Each statement should be reviewed by the patient and should be questioned if necessary. Sedation Consent Form. Vidalia Veterinary Clinic. This sedation will be "light conscious sedation" where my pet will maintain protective reflexes, however, they will be less aware of their environment. Veterinary Service Client Name * First. In addition to this letter, you will find that the following information has been enclosed: 1. endstream endobj startxref Pet Name *. 20115 44th Avenue West, Lynnwood, WA 98036. Sedation Consent The following agreement is made between Austin Veterinary Emergency & Specialty Center and the person named below who represents him or himself to be the owner or owner’s agent. Surgery, Sedation, and Anesthesia Information and Consent. understand that sedation and anesthesia involves minimal risk to my pet, but I won’t hold your clinic liable in any manner whatsoever or under any circumstances in connection with this procedure. 3.) I hereby certify that I am the owner or owner's representative of the pet or am responsible for him. Sedation Consent Form. I understand that complications can include unexpected death, and this can happen at any time, including before, during or after the anesthetic procedure. I have had an opportunity to discuss the risks of sedation and the proposed procedure with the attending doctor. In addition to this letter, you will find that the following information has been enclosed: 1. 72 0 obj <>/Filter/FlateDecode/ID[<95D8C6C232D04F4F966AAACF02F36C0F><1F0A5125AF02B94195C035E433CF6324>]/Index[53 39]/Info 52 0 R/Length 85/Prev 72552/Root 54 0 R/Size 92/Type/XRef/W[1 3 1]>>stream I, the undersigned owner or agent of the owner of , certify that I am eighteen years of age or over and authorize the veterinarian (s) at this practice to perform the above procedure (s). I understand that support personnel will be used as needed by the veterinarian. Address Line 2. Sometimes during examination, teeth are found ... Grooming Sedation/Anesthesia Form hÞbbd```b``Z"—‚I0¹D2¬Db¯B°¡"+ÐEØςH¶ó`3•@dz$X¶H26rÉÿÿ¦20í «ÊМüÏÀ¸â=@€ é: Terms of Use & Privacy Policy. I accept that every precaution is taken to ensure the safety of my pet. Sedation is the use of a medication (“sedative”) to relax an animal. hÞb``d``êc```d,a@,`̱ M¤ŒV00D00‚!˜d ‘lªlêUiÎ6$3º@4…Y˜À4Óu ÍÅÀ²²=ÕYÈêd» ‘b>*ÅÊÀ(9"ÅÈ` ¿¼F Information; Name * First Last. Owner: ... Propsect Veterinary Clinic’s doctors to use reasonable care and judgement in performing these procedures. For general information, questions, appointment requests, call us at: (912) 537-1069 Fax: (912) 537-1113 Email Us: vidaliaveterinaryclinic@gmail.com Anesthetic/Sedation Procedure Required Consent Form. This also allows us quick access to veins in case of an emergency situation. Signature Date Signature of Owner or Agent: Please fill out this form to help us prepare for your visit. The Veterinary Specialty Center of Seattle is now offering remote healthcare services with TeleVet. Dear Client, Your pet has been scheduled for surgery in the near future. Today's Date * Owner's Name * First. I agree. It has been deemed by the veterinarians at Mainstay Veterinary Practice that your pet will require reversible sedation for the above procedures to be performed. Dental Procedure Consent Form I am admitting my pet for a dental prophylaxis which is performed under general anesthesia. My signature on this consent form indicates that any questions have been answered to my satisfaction. 1.) I understand that Veterinary Specialty Center and its doctors cannot predict complications. 2.) I hereby authorize the performance of the procedure (s) and/or treatment (s) listed. I certify that I am over the age of 18 and have permission to act as the representative. I consent for sedation/anesthesia or I DO NOT consent Please type your name for signature: An IV catheter placement is REQUIRED for all anesthetized/surgical patients regardless of age. In our attempt to assist clients, we have assembled this packet to make surgery day as easy and stress-free as possible. I hereby consent and authorize for the Veterinary Specialty Center and its staff to sedate/anesthetize my pet and perform the procedures and/or surgery that has been discussed with me. The risk associated with sedation has been explained to me. I hereby certify that I am the owner of the above named animal or I am responsible for the above named animal and have the authority to execute this consent. The document is also used to provide consent for said sedation. Sedation & Anesthesia Consent I hereby authorize this veterinarian to use sedation, tranquilization and/or general anesthesia as required on my pet, my pet, for the above treatment/surgery listed on this estimate. This placement allows the veterinary staff to administer fluids to maintain hydration and blood pressure. %%EOF To be completed anytime your pet will be admitted for the day for services that may require sedation. Veterinary Forms Fill out any of the forms we have provided below for your convenience. Vidalia, GA 30474. Sedation Consent Form. Name *. CALL US. APPOINTMENT. Dear Client, Your pet has been scheduled for surgery in the near future. * I have read, understand, and authorize Sedation Consent Form. In our attempt to assist clients, we have assembled this packet to make surgery day as easy and stress-free as possible. SEDATION CONSENT FORM. I have elected conscious sedation for your pet's procedure today. Day Admission with Sedation Consent Form. Surgery, Sedation, and Anesthesia Information and Consent. Click "Choose File" & attach your form… You, the undersigned, have read, understand and consent to the above surgery/anesthesia consent agreement. This form is not necessary for dental or surgical procedures. Sedation Consent Form. I hereby certify that I am the owner or owner's representative of the pet or am responsible for him. Consent *. In our attempt to assist clients, we have assembled this packet to make surgery day as easy and stress-free as possible. Design by I have been advised on the nature of the treatment that will be performed and I realize the results cannot be guaranteed. Consent *. You should use this Veterinary Surgical Consent Form Sample instead of creating a consent form manually. You must bring the form printed and filled out on your next visit. Sedation Consent Form. Complete the form and save it to your computer. Contact Us. Pet's Name * Procedures. I give my permission for my pet to be sedated for the above listed procedure. I understand that sedation or anesthesia poses a risk to my pet, regardless of health status. I understand some risks always exist with anesthesia and/or sedation, and I am encouraged to discuss any concerns I have about those risks with my veterinarian before the procedure(s) are initiated. Address * Address Line 1. Proudly Designed & Managed by ViziSites. I also consent to treatment of any unforeseen emergency. I understand that chemical sedation/anesthesia and surgery always carry some element of risk and that by signing this, I share in assuming those risks. I accept that every precaution is taken to ensure the safety of my pet. While Advanced Veterinary Medical Center provides the highest quality of anesthesia monitoring and surgical services, I understand that there are rare complications associated with any anesthetic or surgical procedure. I understand that every safety measure will be taken to assure the most positive outcome possible. I acknowledge that my pet is scheduled for a procedure which may or may not include surgery with anesthesia or a sedative. I authorize the use of professionally accepted general anesthesia to perform the above procedures or surgery as deemed necessary by the doctor (s). Drop Off Consent Form - with sedation Please fill out ALL fields below before your pet's next appointment: You can submit our “Sedation Consent Form” in two ways: 1) Fill out and print our Sedation Consent Form here. In the case of medical emergencies and unexpected treatment decision making, the doctor will need your permission and time is critical both during medical emergencies and when a pet is anesthetized. © 2021 Veterinary Specialty Center of Seattle. Participants with concerns about any research study at the AU College of Veterinary Medicine may also contact: Doug Allen, DVM, MS, DACVS. We attempt to discuss all aspects of care with you: however, we cannot predict every circumstance or situation which may occur while your pet is present in our hospital. I have read this consent form and agree to assume all risks. I give my permission for my pet to be sedated for the above listed procedure. SEDATION CONSENT. Sedation Anesthesia Consent Digital Empathy 2019-05-04T07:29:16+00:00. It is extremely important that you are reachable by phone today. 91 0 obj <>stream understood the risks involved, including death, have the authority to grant you my consent to receive, prescribe for, treat, and sedate my pet for grooming. I understand that in order for my pet to stay in the hospital they must be current on all vaccines and must have recent bloodwork to assess organ function. In addition to this letter, you will find that the following information has been enclosed: 1. Sedation/Treatment Consent Form . 2) Fill out our form online: All required fields are marked [*] Pet Name: *. The conscious sedation consent form should be used to ensure that patients have a complete understanding of the sedation that will be provided along with their treatment. Pre-Appointment Forms Appointment Form – Follow-Up Appointment Form – Sick Pet Appointment Form – Well Pet Anesthesia Consent Form Dental Consent Form New Client… endstream endobj 54 0 obj <. I recognize and understand that occasional complications can occur due to preexisting conditions that are not evident during routine physical exams. My doctor has talked with me regarding these risks and my questions have been answered to my satisfaction. 303 W 1st Street. Sedation Consent From. I agree to all statements and terms of this consent form. Last. I certify that I am over the age of 18 and have permission to act as the representative. I authorize the use of appropriate sedatives; and I understand that hospital support personnel will be employed as deemed necessary by the veterinarian. ... We appreciate your patience and willingness to abide by this new format of veterinary healthcare. 53 0 obj <> endobj Veterinary Surgical Consent Template has the pet information, owner details, surgery information, and authorization or consent that the medical staff requires the pet owner to start the surgery. 0 The nature and risks of this procedure have been explained to me.
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