Sedation Consent Form

Your Name*
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Best contact number to reach you at in the event of an emergency:*
Your Cat's Name*
I authorize my pet to be sedated for services today. I have been informed of the risks of sedation and the nature(s) of the procedure my pet will be receiving today. I understand that no outcome or cure is guaranteed following today’s procedure. I agree that I will not hold The Feline Hospital or its associates responsible for the patient’s outcome or recovery. I agree to pay in full for services rendered today. I have been advised to the approximate cost of services today up to the amount of: The Feline Hospital has the ability to perform CPR in the event of an unforeseen complication or emergency. There may be additional costs to perform CPR if it is needed, and there is risk of injury associated with the acts required in performing cardiopulmonary resuscitation. I understand that the approximate percentage of my pet making a full recovery after suffering a cardiopulmonary arrest are less than 10%. By approving CPR, I understand that there is no guarantee of a positive outcome for my pet and I agree not to hold The Feline Hospital responsible for any outcome.
Please choose one*
- I would like to have CPR performed on my pet in the event of an emergency.
- I would not like for CPR to be performed on my pet in the event of an emergency.
Please give us a brief medical history of your cat.*
In typing my full name below in lieu of a written signature, I agree that I have read, understood, and agree to, in full, the above statements.
Client’s Full Name (Typed)*
Signature*
Date
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Sedation Consent Form

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