Owner's Name* First Last Pet's Name*Phone*Anesthetic Consent Form for* Elective Procedure Non-Elective ProcedureType of Procedure*Vaccination Status* Current on Rabies Vaccine?Is the pet fasted?* Yes NoI hereby certify that I am the owner of the above named pet or am responsible for it and have the authority to authorize the following procedures*Additional Services available while you pet is sedated:* Ear Cleaning (Pull ear hair = $55.24) Dentistry (pricing varies, please ask for an estimate) If extraction are needed I would like you to perform any necessary extractions. If extraction are needed I would like you to call me before doing any extractions** Microchip = $57.84 Fecal Combo (Intestinal Parasite check) = $50.00 Express Anal Glands = $39.51 Nail Trim = Complimentary with anesthetic procedure**NOTE: I understand that if I am not available when I am called for authorization no extraction will be performed. I further acknowledge that this will mean my pet may have to be sedated again to have the extractions performed at an additional cost.* I also authorize the use of such anesthetic, as you deem advisable, in the performance of such surgical, diagnostic procedures. I realize the administration of any anesthetic agent carries a small, but realistic, possibility of side effect that may include death.* I recognize the nature of the procedure(s) being performed and realize that certain risks and complications may be involved. I acknowledge that no guarantee or assurance has been given as to the result that may be obtained.Advances in anesthesia have made routine procedures safer, with low incidence of complications; however, occasional problems can occur due to pre-existing conditions not evident during routine histories and physical examinations.* I understandIn the event of an emergency I would like BFAH to:* Perform CPR and make every reasonable efforts to save my pets life up to (CPR ranges $300-$500) DO NOT RESUSCITATE* I agree to hold Best Friends Animal Hospital and its Doctors and employees harmless from and against any and all liability, in the absence of negligence, for untoward anesthetic complications.Signature*(Please type your full name)Δ
