Veterinary Anesthesia Consent Form

This is a 100% free and printable template for veterinary practices. This form is used to obtain the owner's or authorized agent’s consent for administering anesthesia, sedation, and any necessary surgical or medical procedures. Print it or download it as a PDF.

Veterinary Clinic

Anesthesia Consent

Owner Name:
Date:
Phone (Mobile or Work):
Patient Name:
Species/Breed:
Color:
Age:
Sex:
Weight:

Procedure(s) Requiring Anesthesia or Sedation:

Estimated Cost Range or Quote:

Informed Consent and Liability Waiver:

☐I understand that all anesthesia and sedation procedures involve certain risks, which have been explained to me. The veterinary team will take reasonable precautions to minimize these risks.
☐I hereby authorize the veterinarian to perform the procedures listed above, as well as additional procedures that may become necessary if I cannot be reached. I understand any unforeseen complications could result in further costs.
☐Should unexpected conditions arise, and if the clinic is unable to contact me, I understand the veterinarian will act in the best interest of my pet.
☐I agree to pay for services rendered and understand that the final cost may vary from the estimate if additional treatments or interventions become necessary.
Owner/Authorized Agent Signature:
Date:

Download or print this template under the Customize Template section.

This document confirms that the owner (or authorized agent) understands and agrees to the anesthesia or sedation process, including potential risks, costs, and the possibility of additional treatments.
It ensures informed decision-making, protects both the veterinary practice and the owner, and provides legal documentation that the owner consents to the procedures and any related costs.
The form must be signed by the pet’s legal owner or an authorized representative with the authority to make medical decisions for the animal. A co-signer or guardian may be required if the individual is under 18.
It is completed prior to any procedure requiring anesthesia or sedation, such as surgery or diagnostic testing, to ensure that the owner fully understands the process and potential outcomes.

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