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solvangvet@gmail.com

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Appointment
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Anesthesia Consent Form

Get a head start on your pet’s care by submitting our Anesthesia Consent Form online before your upcoming appointment.

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Anesthesia Consent Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Owner Information

Owner's Name *

First

Last

Phone Number (Primary) *

Phone Number (Secondary)

Email Address *

Pet Information

Pet's Name *

Species (Dog, Cat, Etc.) *

Breed

Age

Gender *

Male
Female

Spayed/Neutered *

Yes
No

Pet Health History

Has your pet had food or water in the last 12 hours? *

Yes
No

Any known allergies or adverse reactions to medications or anesthesia? *

Yes
No

If yes, please provide detail: *

Is your pet currently on any medications or supplements? *

Yes
No

Please list medications and dosages: *

Anesthesia and Surgery Authorization *

I authorize anesthesia and/or surgery for my pet. The nature and risks of this procedure have been explained to me. I understand that some risks always exist with anesthesia and/or surgery, and I am encouraged to discuss any concerns I have with my veterinarian before the procedure(s) are initiated. No warranty or guarantee has been given to me as to the results of these treatments or procedures. My signature on this consent form indicates I fully understand these risks and that any questions have been answered to my satisfaction.

Risk Assessment Authorization *

I will not hold Solvang Animal Hospital and Wellness Center, the veterinarians, or any staff member liable for any complications that may arise.

medications or medications

Signature of Pet Owner or Agent *

Clear Signature

Date *

Preferred Method of Contact (Check All That Apply) *

Call
Text
Email

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Address

2025 Mission Drive
Solvang, CA 93463

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Contact Details

Phone: (805) 688-6484
Email: solvangvet@gmail.com

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Hours

Monday – Friday: 8:00 AM – 5:30 PM
Saturday: Closed
Sunday: Closed

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