Exciting changes are happening! Click here to see our construction progress and updates!

Newton Falls, OH

Sedation Consent Form

Save time during your next appointment. Complete your sedation consent form online from any device at any time before your visit.



Online Forms

Sedation Consent Form

Newton Falls Animal Hospital offers our patient forms online so you can complete them before
you come in for your appointment.

Owner's Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Pet's Name *

As owner, or duly authorized agent of the owner, of the above named animal, I hereby consent and authorize the clinic to receive, prescribe, treat or operate on this animal.

Food last 12 hours *

Vomit/Diarrhea *

Reactions *

Pre surgical blood profile *

Yes
No
Third Item

Procedure being performed *

If an animal is admitted into N.F.A.H. and the staff sees fleas, ticks or evidence of fleas and ticks, the pet will be treated at the owners expense. The Ohio Department of Health has made this the law.

Our office is to use all reasonable precautions against injury, escape, or demise but will not be held liable or responsible in any manner regarding the care, treatment or safe keeping of the animal. I understand that I am assuming all risks involved in care and treatment for this animal. I consent to administration of anesthesia as deemed necessary by the doctor. I acknowledge that risks and the possibility of complications exist in any surgical or medical treatment. Our hospital is NOT a 24 hour facility and we do NOT have 24 hour care. During the overnight hours from approximately 7pm- 8am your pet will not be monitored by an individual person. We will inform you if we feel your pet is in a critical condition that should be transported to an emergency facility. Otherwise I consent to hospitalizing my pet without immediate observation and understand the risks associated with this.

An estimate of anticipated fees has or will be given to me on request. A deposit is required upon admittance to the clinic. All charges shall be paid in full upon release. All animals must be picked up by the release date. A written notice will be mailed to the address above. Five (5) days after such written notice, the animal will be considered abandoned and may be disposed of or destroyed as the clinic deems appropraite. It is understood that abandonment does not relieve me from my responsibility of payment for services rendered, including the cost of boarding.

Authorization

I HAVE READ AND FULLY UNDERSTAND THIS SEDATION CONSENT FORM *

Yes

Signature of Responsible Party *

Clear Signature

Date *

Phone