Anesthesia Consent Form

Save time during your next anesthesia consent appointment. Complete your required form online from any device at any time before your visit.

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Anesthesia Consent Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Pet Information

Pet's Name *

Contact Information

Owner's Name *

First

Last

Email *

Phone *

I consent to receive SMS text messages from Hayward Animal Clinic. Msg & data rates may apply. Reply STOP to opt-out. *

Secondary Contact *

First

Last

Secondary Contact Phone *

Today's procedure is: (example: lump removal, exam, etc.)

I authorize Hayward Animal Clinic to perform any additional diagnostic, treatment, or surgical procedure(s) deemed necessary for medical complications or otherwise unforseen circumstances. I understand there are rare complications associated with any anesthetic procedure. No warranty or guarantee has been given to me as to the results or cure afforded by these treatments or procedures. I fully understand these risks and understand the veterinarians and hospital staff will try to minimize such risks. I will not hold West Phoenix Veterinary Hospital, the veterinarians, or any staff member liable for any complications that may arise. *

I have read, understand, and authorize

Payment due upon services rendered *

I have read, understand, and agree

I have read and fully understand this anesthesia consent form *

Signature of Responsible Party

Clear Signature

Date

Phone

Anesthesia Consent Form

Anesthesia Consent Form

Pet Information

Contact Information

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Location

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