Consent for Sedation Form

Owner Name:*

First Last

Date:*

Email:*

Enter Email Confirm Email

Patient Info:*

Pet's name Species (cat or dog)

Patient Birth Date:*

Patient Info:*

Breed	Age	Weight	Color

Patient Sex:*

Female
Spayed Female
Male
Neutered Male

What is your pet’s normal diet?*

Please list any medications or products you would like us to have ready for you today:

Medication/Supplement	Dose	Frequency

Additional services you would like performed for your pet today (Please inquire with our staff at check-in or by phone about the costs of these services):*

Nail trim (courtesy)
Microchip
Anal gland expression
Preliminary hip xray
Hygiene trim/potty patch
Other (Fill in below)
None

Other additional services requested:

Phone number I can be reached at today*

Home or Office

Phone number I can be texted at today:*

Cell

Authorized person to pick up my pet on my behalf:

First Last

SEDATION & PROCEDURE CONSENT*

I authorize sedation and the procedure(s) described above for my pet.

I authorize sedation and the procedure(s) described above for my pet. The nature and risks of this procedure have been explained to me. I understand that some risk exists with sedation and I have discussed any concerns associated with these risks with the veterinarians of Harmony Animal Hospital and their staff before the procedure(s) started. My signature on this consent form indicates that all questions have been answered to my satisfaction. I authorize the veterinarians of Harmony Animal Hospital to perform any additional diagnostics, treatments, or surgical procedures deemed necessary for medical or surgical complications and any unforeseen circumstances that may occur. While Harmony Animal Hospital provides the highest quality of sedation monitoring and surgical services, I understand the risks and understand that the veterinarian and hospital team will do everything possible to reduce these risks. I will not hold Harmony Animal Hospital, the veterinarians, or any team member liable for any complications that may arise.

I HAVE READ AND FULLY UNDERSTAND THIS PROCEDURE AND SEDATION CONSENT FORM.

Please understand that we may NOT contact you regarding the status of your pet prior to 4:30pm unless there is a medical emergency, in which case we will contact immediately.

Please prove you are human by selecting the House.

Comments

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Hospital (919) 303-3456

Resort & Spa (919) 323-8877

Welcome to Harmony Animal Hospital!

Consent for Sedation