Sedation Form - Complete Pet Care Animal Hospital.

Comments

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Sedation Authorization

Client/Pet Information

Select Your Service Location*

Client Name*

First Last

Pet Name*

Email*

Pet Sedation Authorization

I request that my pet receive the following procedure(s), which may require sedation:

Please select all that apply:*

Groom

Wound Care

Bath

Minor surgical procedure

X-rays

Microchip: we recommend completing this while your pet is already being sedated for another procedure

Other

If your pet is on any medications currently, please list them here:

When were they last given?

Sedation Authorization

In order to decrease the stress on your pet for their procedure(s) today, chemical restraint has been recommended. There are different levels of chemical restraint, from mild sedation to full anesthesia. Every animal is different and the level of restraint required varies with each patient.

Sedation Radio*

I give my permission to have my pet sedated if necessary for treatment.

Please do not sedate my pet. I understand that the procedure may not be done.

Initial:*

Bloodwork Authorization

I understand that this procedure may require sedation. Adequate kidney and liver function is essential to the breakdown and removal of common sedatives from the body. A pre-anesthetic panel consisting of a kidney function test (blood urea nitrogen), a liver function test (SGPT), and a red blood cell evaluation is recommended for all sedation patients to assist the doctor in determining the appropriate sedation drugs. If abnormalities are detected, the doctor may recommend further testing, special monitoring during and after sedation, and / or to postpone the procedure at this time.

Bloodwork*

I approve the bloodwork, but understand that it may not be safe or feasible to take a blood sample from my pet without sedation. CPCAH staff will inform me if this is not possible prior to sedation.

I decline the bloodwork.

Initial:*

Risks Acknowledgement

I understand that all pets are handled by Complete Pet Care staff multiple times per day and that my pet will be housed in close proximity to other pets. I understand that there are risks associated with animals being in close proximity, which may include, but are not limited to, respiratory illness, injury from other pets, GI illness, and other infections. I understand that I am responsible for any charges associated with medical care provided to my pet and do not hold Complete Pet Care or its team liable for any illness or injury my pet may incur.
I further understand even with extreme care, rare adverse reactions, which are unpredictable, may occur with any sedation procedure. These reactions may include cardiac arrest, respiratory arrest and death.

Initial:*

Date of Procedure*

Signature*

What phone number would you like text updates be sent to today?*

You will receive a text update from a surgery technician when your pet is finished with surgery and in recovery.

Complete Pet Care

Sedation Authorization

Client/Pet Information

Pet Sedation Authorization

Sedation Authorization

Bloodwork Authorization

Risks Acknowledgement

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