Sedation Consent Form
Clinic & Visit Details
- Date
- Time
Client's Details
- First name
- Last name
- Best contact number today
Patient's Details
- Name
- DOB (age)
- Microchip
- Weight (kg)
- Gender
- Species
- Breed
- Fasted from (date / time)
- Current medications
Sedation Details & Elections
- Procedure requiring sedation
- Estimated cost from ($)
- Estimated cost to ($)
- If sedation is not sufficient, I authorise conversion to general anaesthesia where the veterinarian judges it safer or necessary to complete the procedure
- IV catheter placement
- If plans change or costs are expected to exceed the estimate
- Notes
Consent
I consent to the administration of sedation to the animal described above for the procedure listed, and to conversion to general anaesthesia in line with my election above. I understand that sedation carries risks, including adverse drug reactions, regurgitation and aspiration and, rarely, death, even in apparently healthy animals, and that my animal will be monitored while sedated. I confirm that the history I have provided, including current medications, is accurate, and that any fasting instructions given to me have been followed. I acknowledge that the estimate above is an estimate and not a fixed quote 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.
After sedation: your animal may be drowsy or wobbly for 12 to 24 hours. Keep them indoors, away from stairs, pools and other animals, offer only small amounts of food and water as directed, and contact the clinic if you are concerned at any point.
- Owner / agent name
- Date signed
Owner / agent signature
- Admitting staff member
- Role
Staff signature