Brachycephalic Anesthesia Risk Consent Form - Craig Road Animal Hospital

Please only use this form if directed to by a member of Craig Road Animal Hospital’s staff as this form is used to authorize us to euthanize your pet.

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With full understanding, the undersigned owner/agent authorizes Craig Road veterinary staff to perform, under the anesthetic deemed advisable, said operation/procedure. I understand that further procedures may be therapeutically necessary based on findings during the operation/procedure. I consent to those procedures, their additional cost, and any unexpected lifesaving emergency care deemed necessary by the attending veterinarian. I understand that risks and potential complications exist with anesthesia and surgery and do not hold Craig Road Animal Hospital liable for those risks. Reasonable precautions will be used against injury, escape, or death of this pet. The veterinarians at Craig Road Animal Hospital are doctors of veterinary medicine with an interest in surgery. Board certified surgeons, also known as specialists, may be available to perform this procedure at other facilities. Our veterinarians recommend a specialist consultation whenever possible to ensure the most appropriate procedure, and surgeon, for your pet

I am the owner/agent of the described animal and have authority to execute this consent. I hereby authorize consent of the following procedure(s):

Enter Procedure Information (required)

Client Information

Pet Owner's Name (required)

Owner's Phone Number (required)

Owner's Email Address (recommended)

Patient Information

Pet's Name (required)

Pet Breed (required)

Pet's Age (required)

I understand that risks and potential complications exist with anesthesia and surgery and do not hold Craig Road Animal Hospital liable for those risks. The attending veterinarian will perform any necessary lifesaving emergency care and I agree to assume all financial responsibility associated with my decision.

Please Select One (required)
YesNo

I realize that results cannot be guaranteed, and payment is due in full at the time of discharge. By signing below, I indicate that I understand this consent and have an agreement with Craig Road Animal Hospital.

Owner's Signature (required)

Today's Date (required)