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ASK A VET™
Anaesthesia and Surgery Consent Form
By Dr Duncan Houston
A free fillable anaesthesia and surgical consent form for veterinary use, with estimate acknowledgement and opt-ins built in. Type in the details, sign on screen, then print it or download it as a PDF. Nothing you enter is stored or sent anywhere.
Admission Details
Client's Details
Patient's Details
Procedure & Estimate
Intravenous fluid therapy during anaesthesia
(supports blood pressure and recovery)
Pre-anaesthetic blood testing
(screens organ function before anaesthesia)
Microchip while anaesthetised, if not already microchipped
Consent
I consent to the administration of sedation and/or general anaesthesia to the animal described above, and to the procedure(s) listed, together with any additional procedures that are reasonably necessary if an unforeseen condition is found and delay would put my animal's welfare at risk, subject to my contact election above. I understand that anaesthesia and surgery carry risks, including adverse drug reactions and, in rare cases, death, even in apparently healthy animals. I confirm that the fasting instructions given to me have been followed and that the history I have provided is accurate. I acknowledge that the estimate above is an estimate and not a fixed quote, that I will be contacted in line with my election above if costs are expected to exceed it, and that all fees are payable at discharge. I confirm that I am over the age of 18 years and am the owner, or an authorised agent of the owner, of this animal.
Owner / agent signature
Staff signature
Built by Dr Duncan Houston for ASK A VET™ · askavet.com
Free veterinary forms, clinical calculators and pet health tools. Talk. Track. Trust.
Free veterinary forms, clinical calculators and pet health tools. Talk. Track. Trust.
Nothing typed into this form is sent to or stored by askavet.com. All data stays in your browser and leaves only in the PDF or printout you create. This template is general in nature. Check the consent and record-keeping requirements of your local veterinary regulator, and adapt the consent wording to your practice with your own adviser where needed.