Anesthesia Consent Form Anesthesia Consent Form Pet Name * Name * First Last * Last Email * Phone * Mobile Phone Today's procedure is: (example: lump removal, exam, etc.)* * Please select any/all that you would like us to provide while your pet is sedated Implant Microchip Sanitary Clip (rectum, genitals) Express Anal Glands Clean Ears Nail Trim Remove Lumps (specify location of lumps below) OtherOther Specify location of lumps I authorize Leo's Pet Care to perform any additional diagnostic, treatment, or surgical procedures 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 Leo's Pet Care, the veterinarians, or any staff member liable for any complications that may arise. * I have read, understand, and agree Payment due upon services rendered. * I have read, understand, and agree I have read and fully understand the anesthesia consent form. Date Signed * Captcha Submit If you are human, leave this field blank.
