Anesthesia Consent Form

Arden Animal Hospital

1823 Fulton Avenue
Sacramento, CA 95825

(916)485-5412

www.ardenanimalhospital.com

Client Name (required)

First Name (required)	Last Name (required)

Pet's Name (required)

Procedure to be performed (required)

Please Read:

I have been given a copy of an estimate and understand the charges (required)

Yes
No

Pre-Anesthetic Blood Work

Please pick one: (required)

I DO want pre-anesthetic blood work for my pet
I DECLINE pre-anesthetic blood work for my pet

IV Fluids

Please pick one: (required)

I DO want an IV catheter and fluid support for my pet
I DECLINE an IV catheter and fluid support for my pet

Pain Control

Microchip Implantation

Please pick one: (required)

I DO want a microchip implanted
I DO NOT want a microchip implanted

Toe Nail Trim

Please pick one: (required)

I DO want a toenail trim for my pet
I DO NOT want a toenail trim for my pet

Please read:

By selecting below, this is your electronic signature for this online form: (required)

I agree
I do not agree

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