Sedation Form

Hebron Cat Hospital

1617 W. Hebron Pkwy
Carrollton, TX 75010-6334

(972)394-9228

www.hebroncathospital.com

Sedation Form

If you would like, we also have printable forms available for you to print out and bring in with you.

Name (required)

First Name (required)	Last Name (required)

Pet's Name

Emergency Phone Number (Please be available throughout the day) *(required)*
Phone Type	Phone Number (required)

May we use the number above to text you information about your pet?

yes
no

Alternate Phone Number
Phone Type	Phone Number

May we use the number above to text you information about your pet?

yes
no

E-Mail Address :

*Pick up will be after 4:30pm if available the same day*

Procedure(s) to be performed (required)

Are there any other services you would like performed today while your pet is under sedation?

I understand by checking these boxes I am initialing additional procedures at additional cost.

Please complete a urinalysis. (Recommended if >6 yr)

Please radiograph my pet's chest to detect possible heart/lung disease. (Recommended if>6yr)

Please scan my pet, if no microchip is found, please permanently identify with a microchip.

Please trim my pet's nails if indicated.

Please clean my pet's ears if indicated.

Please express my pet's anal glands.

Please apply soft paws while my cat is sedated.

In the event that my companion animal arrests while hospitalized at Hebron Cat Hospital

I authorize the following CPR code: (required)
(by checking the box you are initialing your choice)

Normal CPR: involving chest compressions, oxygen therapy and medications such as epinephrine, atropine, etc
DNR: No resuscitation

Final Authorization:

Please read carefully
I am the owner/agent for described animal and I authorize and request the services listed on this form and discussed above. I have indicated any additional services I would like performed with my initials and checked boxes. I understand that during the performance of the foregoing procedure(s) or operation(s), unforeseen conditions may be revealed that necessitate an extension of the foregoing procedure(s) or different procedure(s) than those set forth above. Therefore, I hereby consent to and authorize the performance of such procedure(s) as are necessary and desirable in the exercise of the veterinarian's professional judgment. I also authorize the use of appropriate anesthetics, other medications and I understand that hospital support personnel will be employed as deemed necessary by the veterinarian. I have been advised as to the natures of the procedure(s) or operation(s) and the risks involved. I realize that results cannot be guaranteed.

I understand that I will be charged for flea medication administered if evidence of fleas is found.

I understand that if my cat has heavy matting (during a lion cut) I will be charged an extra fee.

To the best of my knowledge, my pet has not had any food since 10pm the night before the procedure. (required)

I have read and understand this authorization and consent. (required)

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