Skip to content
For Dogs · WOOPF™, opens in a new tabCare about your pet? Download ASK A VET!For Cats · PURRZ™, opens in a new tab
ASK A VET

Sedation Consent Form

A free fillable sedation-only consent for imaging, wound care, grooming and minor procedures, with a conversion-to-anaesthesia election built in. Sign on screen, then print or save as a PDF. Patient and owner details are never stored or sent anywhere.

Clinic

Clinic & Visit Details

Client

Client's Details

Patient

Patient's Details

(if instructed)

Sedation

Sedation Details & Elections

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

(recommended: immediate venous access if needed)

Consent

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 signature
Staff signature
Preview

Sedation Consent Form

Live preview · prints exactly like this

Sedation Consent Form

Clinic & Visit Details

Date
Time

Client's Details

First name
Last name
Best contact number today
Email

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

Built by Dr Duncan Houston for Ask A Vet · askavet.com

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 wording to your practice with your own adviser where needed.

Dr Duncan Houston
About the author

Dr Duncan Houston · BVSc, Veterinarian

Emergency careGeneral practiceMobile vet careFounder, ASK A VET™

Dr Duncan Houston is an Australian veterinarian with experience in emergency, general-practice and mobile veterinary care. He is the founder of ASK A VET™. This guide is educational and is not a substitute for hands-on veterinary care.

When Remember is on, this page saves your clinic's details in this browser only. Owner and patient details are never saved. It is never sent to Ask A Vet. Use Forget to remove them from this computer.