Sedation / Anesthesia Consent Form Client Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Patient Name*SpeciesBreedSexColorWeightProcedure(s) to be performed*Would you like a pawdicure performed (nail trim) $12.25?* Yes No Would you like your pet to have a microchip implanted (includes registration) $40?* Yes No Would you like an anal gland expression while under sedation/anesthesia $18.25?* Yes No I, the undersigned owner or agent of the pet identified above, authorize the veterinarian and staff of Blue Oasis Pet Hospital to perform the above procedure(s). I understand that some risks always exist with sedation and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure(s) is/are initiated. I understand that the attending veterinarian will make every effort to contact me regarding treatment in the case of unforeseen emergencies. If unable to contact me, the staff may or may not have my permission to proceed with life sustaining procedures.* I give my permission (yes) I do not give my permission (no) DNR While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved. I also assume full responsibility for any additional expenses incurred after the procedure is performed, such as follow up radiographs, re-check physical exams and complications. These are more likely to occur when there is a failure to comply with the aftercare instructions. Are you staying during the procedure: If yes, I understand that I may be exposed to radiation and/or gas anesthesia; and, hereby give my consent to stay understanding these risks. I have read and fully understand the terms and conditions set forth above. Signature of Owner*Date*Phone number(s) at which owner can be reached today or tomorrow:*We require confirmation of surgical appointments 48 hours prior to the scheduled procedure. All surgical no-shows or last-minute cancellations (less than 48-hour notice) will forfeit the $100 scheduling deposit. If the appointment is rescheduled more than 48 hours beforehand, the deposit will still be applied.CommentsThis field is for validation purposes and should be left unchanged.