Anesthetic Consent Form

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[esigtextfield name="esig-sif-1610130486128" verifysigner="undefined" size="undefined" label="When did your pet east last?" displaytype="plaintext" required="1" ]
[esigtextfield name="esig-sif-1610130490704" verifysigner="undefined" size="undefined" label="Medications" displaytype="plaintext" required="0" ]
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I, being responsible for [esigtextfield name="esig-sif-1610130392733" verifysigner="undefined" size="undefined" label="Your Pet Name" displaytype="plaintext" required="1" ], have the authority to grant Lakeside Animal Hospital my consent to receive, prescribe for, treat, and/or operate upon my pet. By signing this form below I understand that if my pet is not free of external parasites such as fleas, and/or ticks, my pet will be treated appropriately at my expense. I understand that my pet must be up to date on needed vaccinations such as rabies, distemper, and Bordetella in order to be hospitalized for any period of time at Lakeside Animal Hospital. Otherwise, my pet will be treated at my expense. I understand that pre-anesthetic blood work will be done, at the owner's expense, prior to the patient being anesthetized for his/her safety. I understand that Lakeside Animal Hospital does NOT provide 24 hour staffing for any animal left overnight at the hospital. Staffing hours are Mon-Fri 7am-7pm; Sat 7am,-1pm. IF my pet is having a dental procedure performed today, I authorize the veterinarian to perform any extractions deemed necessary at the veterinarian’s discretion. I understand that there is potentially an additional cost for this procedure at the owner's expense. I understand that in the case of an emergency, Lakeside Animal Hospital will do their best in contacting me appropriately as matters appear. If I am unable to be reached, I give Lakeside Animal Hospital permission to do as they see fit in for treating my pet.
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Signature Certificate
Document name: Anesthetic Consent Form
lock iconUnique Document ID: 8e106088d8221f27fc40de78bee160c3612c951d
Timestamp Audit
January 8, 2021 6:25 pm EDTAnesthetic Consent Form Uploaded by Sherry Burgess - IP
January 13, 2021 12:38 pm EDT Document owner has handed over this document to 2021-01-13 12:38:04 -