Sedated Release Form The following information is necessary in order that we might serve you better and give you personal attention. Please fill out the form completely. Owner's Name* First Last Pet's Name*We MUST have a way to contact you while your pet is in our hospital. Occasionally situations will arise which require your approval to proceed. If we cannot get in contact with you within 5 minutes, the procedure may be aborted and you will be responsible for charges already incurred.Phone*I am the owner of agent of the above-described animal and have the authority to execute this consent. I hereby consent and authorize the performance of the following procedure(s) or operation(s):*and authorize the performance of other procedure(s) or operation(s) necessary and desired in the exercising of the veterinarian's professional judgement. The nature of such service has been described to me to my satisfaction and I realize that no guarantee, or warranty can ethically or professionally be made regarding the results or cure.I understand that surgery carries some risk regardless of health status. I have been advised that there is a risk of death every time an anesthetic is used and that possibility (small as it may be) has been explained to me. In the event of unforeseen complications, I give permission for the doctors and staffto take reasonable measures in treating my pet and accept all charges that are incurred as a result of such action.Resuscitation OrderPlease read the following carefully and initial next to procedures you wish to be performed in the case of an emergency.In the event of cardiac or respiratory arrest I authorize the responsible veterinarian to resuscitate my pet by performing one or more of the following procedures:*YES to resuscitationNO to resuscitation I consent in the event of cardiac or respiratory arrest that NO attempts to resuscitate my pet be performed.) Post-resuscitation procedure care most likely will include overnight monitoring at a 24-hour emergency facility at additional cost to the client.1. External Cardiac Massage (CCPR) Cost range $100-$400.2. Internal Cardiac Massage Cost Range $400-$2000I understand that I assume financial responsibility for all services rendered, and that payment is expected on the day of surgery. Any medications and supplies purchased will be at an additional charge. (Signature)*Date* EmailThis field is for validation purposes and should be left unchanged.