Anesthetic Consent Form

  • Date Format: MM slash DD slash YYYY
  • Owner's Name

  • The number we can contact you at on the morning of the surgery.
  • Pet Information


    I, hereby authorize LaSalle Animal Hospital to use general anesthesia on my pet named above for the treatment/surgery. I understand that some risks always exist with anesthesia and/or surgery and that I am encouraged to discuss any concerns that I have about those risks with the veterinarian before the procedure is initiated.

    By testing your pet before anesthesia, you help reduce his or her risk of anesthetic complication. Pre-anesthetic testing helps understand whether your pets' vital organs are functioning properly and that your pet can properly process and eliminate anesthesia. Just like when people undergo an anesthetic procedure, your doctor would perform pre-anesthetic testing.
  • If any of these test results are abnormal, the veterinarian will discuss the findings with you and may decide to do one of the following:1. Postpone the procedure 2. Further testing to pursue a specific diagnosis 3. Proceed with anesthesia, but alter the drugs and procedure(s).