Anesthesia/Surgery Consent Form

Anesthesia can involve some unavoidable risks; we will monitor your pet closely to ensure

his/her safety and wellbeing. Our staff is well trained and we use state-of-the-art-monitoring

equipment at all times. If a problem does arise, we will institute whatever measures are

needed to stabilize you pet.

Dakota Pet Hospital makes great efforts to reduce postoperative complications but

complications can and do occur. I understand that I am financially responsible for any charges

relating to any follow-up care, exams, surgery, anesthesia, medications or supplies

recommended by Dakota Pet Hospital to remedy any complication.

It is very important that we have a valid phone number where you can be reached if

consultation is necessary while your pet is under anesthesia

I hereby authorize Dakota Pet Hospital to perform the anesthetic and surgical procedures

described on my pet. I realize that no guarantee or warranty can ethically or professionally be

made regarding the results of treatment or cure of a problem. I also authorize the clinic staff in

an emergency situation, to follow through with such procedures as are deemed necessary for

the well being of my pet until further communication with me.