Sedation Consent

Sedation Consent

Please complete the following information. All entries are required. You will be redirected to an electronic signature gathering site upon completion of this form.

Procedure Date*
MM slash DD slash YYYY
Name (Primary Guardian and Contact)*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Please provide the best phone number to reach you at during the sedation procedure.
Please select*
In the event we need to contact you, may we use a texting service to reach you at the phone number provided?
Email*
Pet's Name*
Pet's Name
Species*
Please select pet's species.
Age*

Please enter your pet's age. You may approximate if birth date is unknown.
Pet's Breed*

Please enter pet's breed.
Services Estimate*
Please copy and paste the services to be completed during sedation.

Sedation Consent

Contact Information