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Infinity Sedation Consent Form

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We look forward to seeing you soon. Please complete this form before your visit, and we’ll be ready for you and your furry family member when you arrive!

Owner's Name *

First

Last

Email *

Pet's Name *

Service/Procedure *

Please note it is always our goal to complete any service/procedure without sedation/anesthesia, but in some cases, this is not possible. For those cases, we do kindly request pre-approval so that we do not have to wait for approval at the time of the visit and risk running behind schedule for those patients after. *

I authorize sedation and/or anesthesia for my pet listed above. I understand that there are always risks with sedation and anesthesia, and I am encouraged to discuss any concerns I have about those risks with the referring hospital’s medical staff before the procedure is initiated. I understand the possibility of unforeseen complications that may occur during any associated anesthetic procedure. I fully acknowledge and understand these medical risks. I recognize that the veterinarians and hospital staff will do all that is necessary to minimize such risks. I will not hold the veterinarians or any hospital staff member liable for any complications that may or should arise in my pet’s medical treatment and care.
I decline sedation and/or anesthesia for my pet listed above. I understand that if the staff of IVI is unable to safely complete the service/procedure without sedation that I will still be charged for their time and efforts.

Signature *

Clear Signature

Date *

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