Animal Clinic of Van Wert

Anesthesia Consent Form

Save time on your next appointment by filling out our online anesthesia consent form.

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Animal Clinic of Van Wert Boarding FOrm

Anesthesia Consent Form

Check-in Questionnaire

We recommend that your pet have blood work to check organ function prior to surgery to detect any problems and avoid potential anesthetic complications. THIS TEST IS REQUIRED FOR PETS THAT ARE 5 YEARS OR OLDER.
We recommend checking heartworm status prior to surgery to dect any problems and avoid potential anesthetic complications. THIS TEST IS REQUIRED FOR DOGS THAT ARE 2 YEARS OR OLDER.
A microchip can be placed under the skin while your pet is in surgery. If your pet gets lost, this can be scanned and the identification number can be look up online. Then the provided contact information can allow the owner to reunite with the pet.

Pain Management: Your pet will receive pain medications at surgery and appropriate medications will be provided to go home with your pet.

Anesthesia Monitoring: Your pet's heart rate, blood pressure, ECG, and Oxygenation will be watched closely during anesthesia to increase safety

Authorization & Informed Consent

I authorize that I am the owner (or Authorized agent for the owners) of the above named pet and authorize the procedures(s) to be performed. I authorize the use of anesthesia and other medications as deemed necessary bu the veterinarian and understand that hospital personnel will be employed in the procedure(s) as directed by the veterinarian. I have been advised as the nature of the procedure to be performed and the risks involved. I understand that there is always a risk associated with any anesthesia episode, even in apparently health animals. I agree to be responsible for all charges incurred while my pet is in the care of this facility and understand full payment is due at the time my pet is released from the hospital. I understand no staff will be attending to my pet overnight.