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20801 N Scottsdale Rd, Suite 101 · Scottsdale, AZ 85255

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ANIMAL HOSPITAL AT GRAYHAWK

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Surgery & sedation consent

Read, complete and sign this before the day of the procedure, or sign it here at drop-off. Online takes about five minutes.

Before anyone starts Pet and owner Email Procedure Medications in the past week Signed Terms as worded at signing Website

You and your pet

First name

Last name

Email

Pet’s name

Phone we can reach you on during the procedure

A second number

Afterwards, would you rather we texted or called?

Text Call

The procedure

Anesthetic or sedated procedure(s) to be performed

Dental procedure Surgery Ultrasound or echocardiogram

Procedure(s), as your veterinarian described them

If we find something beyond what we discussed, what would you like us to do?

Go ahead. Treat what you find while my pet is already under anesthesia. I understand the cost may go up. Call me first, before anything beyond the planned procedure.

Whichever you choose: if we cannot reach you, we do only what would be unsafe or unkind to leave until we have spoken. Nothing elective.

Microchip

Yes, please place one No My pet already has one

There is an additional fee for placing a microchip.

Medications and allergies

Any medications or supplements in the past week?

Yes No

If yes — what, and when was the last dose?

Any other concerns, allergies or procedures

Please read and tick each of these

These are the terms you are agreeing to. Call us before you sign if any of them raises a question.

I am not to feed my pet after 10 PM the night before the procedure. I, the undersigned owner or agent of the pet identified above, authorize the staff of Animal Hospital at Grayhawk to perform the above procedure(s). I understand that some risks always exist with anesthesia, sedation and/or surgery, and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure(s) is/are initiated. I am over 18 and the owner of this pet, or the owner’s authorized agent. I understand that the attending veterinarian will make every effort to contact me regarding treatment in the case of unforeseen emergencies. I have been provided an estimate and approved the estimated cost for the procedure(s) listed above. While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved. I also assume full responsibility for any additional expenses incurred after the procedure is performed, such as follow-up radiographs, re-check physical exams and additional surgery due to post-op complications. I assume financial responsibility for the recommended services and will provide payment in full at the time my pet is discharged from the hospital, unless other arrangements are made in advance. I understand and acknowledge that the hospital is not staffed after normal business hours. The information I have given here — particularly about medications, supplements and allergies — is accurate to the best of my knowledge.

Resuscitation

If my pet’s heart or breathing stops during or immediately after the procedure:

Attempt resuscitation (CPR). Do not attempt resuscitation.

We ask now because an emergency under anesthesia leaves no time to telephone anyone.

Signature By typing my name below I am signing this consent electronically, and I understand it has the same effect as my handwritten signature.

Your full name

The date and time you send this are recorded with it.

Website

That did not send. Please try again. If it still will not send, call us on 480-585-3512, or sign the consent at drop-off.

This form needs JavaScript to send. You can sign the consent at drop-off instead, or call us on 480-585-3512.

This goes into your pet’s record. We do not sell it. What we collect and who receives it.

Questions before you sign

Call us and ask about your pet's procedure.

On the morning

Drop-off for most procedures is between 7:30 and 8 AM
No food after 10 PM the night before; water is fine
Tell the front desk you sent this — that is all that is left to do

What surgery here looks like

Monitoring, pain control and what we do differently →

Animal Hospital at Grayhawk

20801 N Scottsdale Rd, Suite 101
Scottsdale, AZ 85255
480-585-3512

Mon–Fri 7:30 AM – 6:00 PM
Sat 8:00 AM – 12:00 PM
Sun closed

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