Consent for Anesthesia Services

Save time during your next appointment! Complete your required forms online from any device at any time before your visit.

Consent for Anesthesia Services

So that we can prepare for your cat’s procedure, please complete and submit this form at least 48 hours before your scheduled appointment.

Contact Information

Emergency Contact: Please provide the name and phone number of a person authorized to make medical decisions on your behalf in the event that we cannot reach you at the phone number listed above.

Patient Information

Please read the following statements, then sign below.

Anesthesia Technique Expected Result Technique Risks Include but are not Limited to:
General Anesthesia Completely unconscious state, does not respond to external stimuli or feel pain Drugs are injected into the bloodstream, and a tube is placed in the windpipe to administer oxygen and anesthetic gas Hoarseness (sore throat), injury to trachea, injury to blood vessels, vomiting, aspiration, pneumonia
Sedation Semi-conscious state, reduced anxiety and pain Drugs are injected into the bloodstream or into the muscle, oxygen is provided by face mask or by holding the oxygen tubing close to the patient’s the face An unconscious state, depressed breathing, injury to blood vessels, vomiting, aspiration, pneumonia
Locoregional Anesthesia Temporary loss of feeling and/or movement in a particular location or region of the body Drugs are injected near nerves or placed directly into the surgical site, providing loss of sensation in the local area Infection, weakness, persistent numbness, residual pain (requiring additional anesthesia)