Please note: We will be closed on Thursday, November 28th and Friday, November 29th in observance of Thanksgiving!

Anesthesia Consent Form

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Anesthesia Consent Form

Name *

First

Last

Email *

Procedure: *

I authorize the doctors at Broderick Animal Clinic to anesthetize or perform any surgical procedures discussed necessary for my pet. I understand that no surgical procedure is without some risks, including complications that could develop during the procedure. I agree to full financial responsibility for the balance due at the time my pet is discharged.

Would you like to update any past due or upcoming (within 2 months) vaccines today if the doctor is ok with it?

If your pet is not microchipped, would you like us to administer one today during their procedure for an additional cost?

Pre-Operative Comprehensive Blood Work: Every patient receives a physical exam prior to anesthesia. However, if your pet is over the age of 7 years, we strongly recommend pre-op blood work to rule out any underlying or re-existing (liver or kidney) diseases before going under anesthesia.

Yes, I give permission for blood work to be done for my pet prior to anesthesia for an additional cost. If abnormalities are found, please call and inform me at the following number provided.
I give permission to perform blood work only if recommended by the doctor.
NO, I have elected to decline comprehensive blood work for my pet at this time.

Signature *

Clear Signature

Date *

Anesthesia Consent Form

Anesthesia Consent Form

Medical Emergency After Hours?

Blue Pearl – Iowa Veterinary Referral Center
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(515) 280-3100

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