Pet's Name* Owner's Name* First Last Email* Phone*Emergency Phone Number*Today's procedure is: (Example: lump removal, exam, etc.)*Additional Services Desired While Patient Is SedatedCheckboxes Implant Microchip Clean Ears Sanitary Clip (rectum, genitals) Nail Trim Express Anal Glands Remove Lumps (specify location of lumps below) Other (specify below) If Other, please explain:* I authorize anesthesia/sedation for my pet. The nature and risks of this procedure have been explained to me. I understand some risks always exist with anesthesia and/or sedation, and I am encouraged to discuss any concerns I have about those risks with my veterinarian before the procedure(s) are initiated. My signature on this consent form indicates that any questions have been answered to my satisfaction.* I have read and understand I authorize Edmonds-Westgate Veterinary Hospital to perform any additional diagnostic, treatment, or surgical procedure(s) deemed necessary for medical complications or otherwise unforseen circumstances. I understand there are rare complications associated with any anesthetic procedure. No warranty or guarantee has been given to me as to the results or cure afforded by these treatments or procedures. I fully understand these risks and understand the veterinarians and hospital staff will try to minimize such risks. I will not hold Edmonds-Westgate Veterinary Hospital, the veterinarians, or any staff member liable for any complications that may arise.* I have read, understand, and authorize Payment due upon services rendered.* I have read, understand, and agree. Signature* Date* MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged.
