Sedation Consent Form

You can submit our “Sedation Consent Form” in two ways:
1) Fill out and print our Sedation Consent Form. Bring the form printed and filled out or emailed for your visit.
2) Fill out our form online:

Sedation Consent Form

* Indicates required field

Pet Name *

Client Name *

First

Last

Phone Number *

I hereby certify that I am the owner of the above-named animal or am responsible for it and have the authority to execute this content. *

I agree

Email *

Procedure(s) *

Has your pet been in contact with anyone diagnosed with or suspicious for COVID-19 in the past 2 weeks? *

Yes No

I hereby authorize the use of such anesthetics as you deem advisable and performance of such surgical or therapeutic procedures as you determine to be indicated. *

I agree

I agree to indemnify and hold Mountain View Veterinary Hospital harmless from and against any and all liability arising out of the performance of any of the procedures referred to above. *

I agree

What phone number(s) can you be reached at today? *

Are there any times you will be unavailable? *

Entering Your Full Name Here Will Serve As Your Digital Signature *

Date *

Submit