Sedation Consent Form

Your pet’s safety and comfort are always our top priority. Sedation is sometimes necessary to perform medical procedures safely and with as little stress as possible. This consent form ensures that you understand the sedation process, associated risks, and authorizations needed before your pet’s procedure.

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About This Form

This form authorizes our veterinary team to sedate your pet for the requested procedure. It provides us with critical information about your pet and outlines your consent regarding anesthesia, medical treatment, and emergency decisions. Completing this form in advance helps us prepare for your pet’s visit and ensures the best possible care.

Client Information

Name *

First

Last

Email *

Phone Number *

Please enter a valid phone number.

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Patient Information

Pet's Name *

Pet's Breed *

Pet's Sex *

Male
Female

Pet's Age *

If unsure, indicate as “listed in records"

Pet's Color *

Procedure Requested and the Approved Estimated Cost *

Authorization

I have read and fully understand this sedation consent form. I authorize anesthesia and sedation for my pet, as described above. The nature and risks of this procedure have been explained to me. I understand that some risks always exist with anesthesia and sedation, and I am encouraged to discuss any concerns with the hospital’s medical staff before the procedure is initiated. Additionally, I authorize River Run Animal Hospital to perform any diagnostic or medical treatment as deemed necessary if unforeseen complications arise. While River Run provides the highest quality of anesthetic monitoring and veterinary services, I fully acknowledge the possibility of unforeseen complications. I recognize that the veterinarians and hospital staff will do all that is necessary to minimize such risks. I will hold harmless River Run Animal Hospital, the veterinarians, or any hospital staff member for complications that may arise in my pet’s medical treatment and care. I understand the hospital is not liable for any lost or damaged personal property (leashes, collars, etc.) left in the hospital.

CPR / DNR Consent

You are being presented with this form because your pet is either critically ill or is being hospitalized. If critically ill, this condition may cause him/her to stop breathing (respiratory arrest) or cause the heart to stop beating (cardiopulmonary arrest). If this happens, your pet will die unless immediate resuscitation is started.

It is best to consider this possibility and make a decision before the need arises. This allows you to be fully informed and ask questions. You must understand that the prognosis is grave if your pet arrests. Please consider your pet’s condition when making this decision. If your pet has a terminal illness, resuscitation is not encouraged.

⚠️ Keep in mind: with any arrest, it is highly likely that the arrest will reoccur within 4 hours. Performing CPR will also incur charges beyond the initial estimate.

Should unexpected life-saving emergency care be required and the hospital staff is unable to reach me*

Owner Signature *

Clear Signature

Date *

Owner Name (Printed) *

First

Last

Sedation Consent Form

About This Form

Client Information

Patient Information

Authorization

CPR / DNR Consent

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