General Anesthesia and Sedation Consent Form Pet's Name* First Last Date MM slash DD slash YYYY SpeciesAgeSexWeightPhone 1*Phone 2Owner Name First Last When did your pet last eat?* Is your pet coughing, sneezing, vomiting or having diarrhea? If yes, please provide details.* What medications is your pet receiving at home?* Has your pet been scratching, itching or scooting?* I certify that I am the legal owner/duly authorized agent for the owner of the animal described above, and do herby authorize Murphy Avenue Pet Clinic to provide care and perform treatment up-to and including diagnostic bloodwork, x-rays, vaccines, medications and administration of medical procedures they consider reasonable and necessary for my animal’s health, safety and comfort. I understand that with any medical procedure there are always risks involved, including death, and that no warranty or guarantee is being made as to the results or cure. I understand additional charges will accrue if my animal is not picked up before the hospital closes on the day he or she is ready to be released from the hospital. I understand payment in full is expected at the time of pick up and I assume full responsibility for all fees associated with the veterinary services providedI understand every effort will be made to contact me and if I am unreachable my pet’s services may not be performed/completed in their entirety which could result in repeat visits and additional fees.SignatureOwner Type Name CAPTCHA
