Anesthesia release form

Patient Name:

Owner Name:

First Name:

Last Name:

Date:

Phone Number:

Email:

I have reviewed the above material and am comfortable with my allowing my pet to stay for the above procedure(s). I have all my questions answered fully, understand the procedure(s) to be performed and the risks that may go along with them. I hereby state penalty of perjury that I authorize the associates of All 4 Pets Emergency Hospital to perform the above said procedure(s).

I understand the nature and purpose of the procedure(s), risk involved, and possible complications that could arise. I understand there are no guarantees or assurances of the outcome of said procedure(s). I understand that while the anesthetics used in this Emergency Hospital is one of the safest used in Veterinary Medicine, anesthesia is without medical risk. No guarantees can be made legally or ethically to me of any procedure(s) performed. I release All 4 Pets and its associates from liability if something were to go wrong. Should an emergency occur calling for procedure(s) will be performed. I agree to pay fully for all services rendered, including those deemed necessary for medical and surgical complications or other unforeseen.

I hereby authorize the Veterinarians at All 4 Pets to perform upon my pet the following procedure(s).

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Anesthesia release form

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