Owner's Name *

First

Last

Email *

Pet’s Name *

Procedure to be performed *

Primary Phone *

Secondary Phone

Our greatest concern is the welfare of your pet. Before today’s procedure, we will perform a physical examination and notify you of any abnormal findings. During the procedure, we will continually monitor your pet’s vital signs. These precautions will help to minimize risk. However, even healthy patients with close monitoring have a small chance of complications, up to and including death. To further decrease any risks and ensure your pet’s health and safety, we strongly recommend blood testing to identify unseen disorders of the liver, kidneys, and/or immune system.

These pre-sedation blood tests are strongly recommended for all pets, especially those over 7 years of age or with pre-existing medical conditions. Please initial one:

YES, I want my pet to have the recommended blood work (cost is in addition to cost of the procedure)
NO, my pet has had recent blood work (within the past 1-2 months) that the veterinarians has reviewed
NO, I decline the recommended screening and understand the above-stated risks

Please check any additional procedures that you would like us to perform on your pet today (to be completed at the veterinarians discretion):

Please specify other *

Please select one of the following: *

I have received a written estimate for today’s procedure
I would like BAH to call with an estimate prior to my pet’s procedure
I do not require an estimate

Has your pet eaten in the last 8 hours? *

Yes
No

Last time pet has eaten? *

Is your pet acting normally at home? *

Yes
No

Please explain: *

In the event of an emergency, Bay Animal Hospital veterinarians will perform CPR/life-saving measures while we attempt to reach you. Please select and confirm below your authorization: *

Perform CPR
Do Not Perform CPR

Checkboxes *

I have read and understand this consent form and give Bay Animal Hospital permission to sedate my pet. I understand that payment is required in full at pickup and I may be asked to leave a deposit at drop-off

Signature *

Clear Signature

Date *

Sedation Consent Form

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