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Permission to Sedate Form – Glenwood

Name *

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Last

Phone Number *

Pet's Name *

Date of Appointment *

In order to decrease the stress on the animal, chemical restraint for the procedures checked above has been recommended. There are different levels of chemical restraint, from mild sedation to full anesthesia. Every animal is different and the level of chemical restraint required varies with each patient.

I understand that this procedure may require sedation. Adequate kidney and liver function is essential to the breakdown and removal of common sedatives from the body. A pre-anesthetic panel ($83) consisting of a kidney function test (blood urea nitrogen), a liver function test, and a red blood cell evaluation is recommended for all sedation patients to assist the doctor in determining the appropriate sedation drugs. If abnormalities are detected, the doctor may recommend further testing, special monitoring during and after sedation, and / or to postpone the procedure at this time.

I further understand even with extreme care, rare adverse reactions, which are unpredictable, may occur with any sedation procedure. These reactions may include cardiac arrest, respiratory arrest and death. *

Please initial above.

The “Home Again” identification microchip implant ($99) is available for animal’s safety. We are happy to implant this chip today while your animal is already under sedation. If you have any questions about the benefits of the “Home Again” chip, please ask one of our team members.

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Oberlin (Raleigh)	(919) 832-3107
Glenwood (Raleigh)	(919) 783-7387
Tryon (Cary)	(919) 851-7475