Client's Name *

Email *

(for pet reminders and the occasional newsletter)

Pet's Name *

Date of Birth or Age *

Species *

Dog
Cat

Sedation and procedures to be performed: *

I, the undersigned owner or agent of the owner of the pet identified above, certify that I am______/am not________ (check one) eighteen years of age or older and authorize the veterinarians at OAKBROOK ANIMAL HOSPITAL to perform the above procedure(s). I understand that some risks always exist with sedation and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure(s) is initiated. *

I am 18 years of age or older and authorize.
I am not at least 18 years of age.

While I accept that all procedures will be performed to the best of the abilities of the staff at this facility, I certify that no guarantee or warranty has been made regarding the results that may be achieved. I acknowledge that the entire fee is payable when the service is performed. Should unexpected life saving emergency care be required and the hospital’s staff is unable to reach me, the staff has_______/does not have_________ (check one) my permission to provide such treatment and I agree to pay for such services. *

If the staff is unable to reach me, they have my permission to provide treatment.
If the staff is unable to reach me, they DO NOT have my permission to provide treatment.

If your pet has been under anesthesia in the past, has it ever had any anesthetic difficulties? *

Yes
No

If so, please describe the difficulties and drugs used if known. *

Parasites If parasites (ticks, fleas or intestinal worms) are found on your pet while in our facility, they will be treated at your expense to prevent exposure to other pets. *

I have read and understand.

Microchip Identification Implant: Would you like your pet to have a Microchip implanted today. ($66) *

Yes
No

Services Needed (Dog): *

Services Needed (Cat): *

Additional services desired while at hospital:

What, if any, medication is your pet taking?

Time of last dose?

Digital Signature *

Date: *

Daytime Phone (Emergency Contact) *

Can we text this number? *

Yes
No

Sedation Consent Form