Consent for Anesthetic Procedures

Your pet’s safety is our top priority. If your pet is scheduled for an anesthetic procedure, please complete our consent for anesthetic procedures form.

Get Started

Confirming Safe, Informed Treatment

Before any anesthetic procedure, we require signed consent to ensure you understand the recommended treatment, associated risks, and your pet’s care plan. This form helps us maintain clear, informed communication and a high standard of care.

Please complete the form before your pet’s procedure. If you have questions, our team is here to guide you through every step.

Pet Information

Pet's Name *

Contact Information

Owner's Name *

First

Last

Email *

Phone *

Additional Phone

Secondary Contact: *

First

Last

* This person has your authority to consent to medical decisions regarding your pet's surgical care in the event we cannot reach you.

Secondary Contact Phone *

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

Authorization

I authorize anesthesia/sedation for my pet. The nature and risks of this procedure have been explained to me. I understand some risks always exist with anesthesia and/or sedation, and I am encouraged to discuss any concerns I have about those risks with my veterinarian before the procedure(s) are initiated. My signature on this consent form indicates that any questions have been answered to my satisfaction. *

I have read, understand, and authorize

I authorize Carolina Animal Eye 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 Carolina Animal Eye, 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 *

Yes

Signature of Responsible Party *

Clear Signature

Date *

Website

Consent for Anesthetic Procedures

Confirming Safe, Informed Treatment

Pet Information

Contact Information

Authorization

Give Your Pet the Gift of Clear Vision

Have a question?

Location

Contact Information

Hours