"*" indicates required fields

Pet's Name*

Owner's First Name*

Owner's Last Name*

Contact number for today*

Email*

Preferred method of contact*

Call

Text

Last time my pet ate*

Last time my pet went to the bathroom*

What excretions did your pet do*

Urine

Both

I, the undersigned owner, of the pet identified above, authorize Hill Country Veterinary Hospital to sedate my pet for the following procedure*

Hill Country Veterinary Hospital recommends pre-sedative bloodwork before any sedative procedure. This is to help minimize risks during sedation by evaluating the status of your pet’s major organ systems.

I authorize Hill Country Veterinary Hospital to perform pre-sedative bloodwork*

Yes

I hereby authorize anesthesia/sedation for my pet. I understand that some risks always exist with anesthesia/sedation and that rare complications may arise, including anesthetic death. I acknowledge these risks and understand that the veterinarians and hospital staff will try to minimize such risks. I will not hold Hill Country Veterinary Hospital, the veterinarians, or any staff member liable for any complications that may arise.

I have read and understand the above statement. Please initial.*

Full payment is expected at time service is rendered. I understand the risks associated with procedures performed at Hill Country Veterinary Hospital.

Signature*

Date*

This field is for validation purposes and should be left unchanged.

What's Next

1
Call us or schedule an appointment online.
2
Meet with a doctor for an initial exam.
3
Put a plan together for your pet.

Make An Appointment

Sedation Consent Form

What's Next

Call us or schedule an appointment online.

Meet with a doctor for an initial exam.

Put a plan together for your pet.

Where family pets find loving care