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Sedation Consent Form

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Online Forms

Sedation Consent Form

Thank you for choosing Florence Animal Hospital. Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

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.) *

Additional Services Desired While Patient Is Sedated

Please select any/all that you would like us to provide while your pet is sedated

Implant Microchip
Nail Trim
Clean Ears
Express Anal Glands
Sanitary Clip (rectum, genitals)
Remove Lumps (specify location of lumps below)
Other (specify below)

Please specify where the lumps are located *

Please specify the additional service(s) you'd like provided to your pet *

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 Florence Animal Hospital 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 Florence Animal Hospital, 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 *

Signature of Responsible Party *

Date *

Message

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We proudly serve the pets of Omaha, Florence, Fort Calhoun, Crescent IA, Ponca Hills, Raven Oaks, Benson, Omaha Country Club, Lake Cunningham, and beyond. Use the button below to request an appointment with us.

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Contact Information

Phone: 402-451-7001
Email: info@florenceanimalhospital.net

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Hours

Mon – Fri: 8 AM to 5:30 PM
Sat: 8 AM to 12 PM

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Address

8305 N 30th St.
Omaha, NE 68112

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