West Hills Animal Hospital

Surgery and Sedation Consent Form

Complete this required form before your pet undergoes any surgical or sedation procedure at our Knoxville, TN, veterinary hospital.

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Consent Form for Your Pet’s Surgical Care

Your pet’s safety is our top priority. This form provides us with the necessary authorization to perform the recommended procedure and ensures you’re fully informed of the process, potential risks, and care instructions.

Please fill out the surgery and sedation consent form prior to your scheduled procedure to help us provide timely, compassionate care.

Client Information

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Emergency Contact Name *

First

Last

Emergency Contact Phone

Patient Information

Pet's Name *

Age/Date of Birth *

Has your pet had food or water since 10PM last night? *

List any medications (& dosage) your pet is on:

Please indicate which ones have been received in the last 24 hours & what time they were given.

Procedures to be performed today: *

We want your pet to receive the best care available. Prior to your pet’s anesthetic procedure, we will perform a complete exam to ensure the safety of your pet. We recommend performing pre-operative bloodwork ($74) to check the function of organs that are required to process the anesthesia drugs. *

I wish to have pre-operative bloodwork performed on my pet.
I am declining to have pre-operative bloodwork performed on my pet.

I, the undersigned owner or agent of the owner of the pet identified above, certify that I am eighteen years of age or older and authorize the veterinarian(s) at West Hills Animal Hospital to perform the above procedure(s). I understand that some risks always exist with anesthesia and/or surgery and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure(s) is/are initiated. My signature on this form indicates that any questions I have regarding the following issues have been answered to my satisfaction.

The reasonable medical and/or surgical options for my pet
Sufficient details of the procedures to understand what will be performed
How fully my pet will recover and how long it will take
The most common and most serious complications
The length and type of follow-up care and home restraint required
The estimate of the fees for all services

While I accept that all procedures will be performed to the best of the staff’s abilities and that reasonable precautions will be made to ensure my pet’s safety, I understand that no guarantee or warranty has been made regarding the results that may be achieved. If my animal should injure itself, fail to eat, become ill or die, I will not hold West Hills Animal Hospital or its employees responsible.

I agree to pay the estimated fees, assume financial responsibility for the remaining fees, and provide payment in full at the time my pet is discharged from the hospital. Should an unexpected critical situation arise (please choose one): *

I authorize and accept financial responsibility for the veterinarian and staff to perform lifesaving procedures.
I choose that the veterinarian and staff DO NOT resuscitate my pet

I have read and understand the nature of the above procedures and give my consent to proceed. *

I have read and understand the nature of the above procedures and give my consent to proceed.

Signature *

Clear Signature

Date *

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Questions About the Procedure?

Our team is happy to talk you through it.

If you have concerns about sedation, surgery prep, or recovery, don’t hesitate to reach out.

📞 Call (865) 357-1270 or contact us online.

West Hills Animal Hospital

Surgery and Sedation Consent Form

Client Information

Patient Information

Questions About the Procedure?

Our team is happy to talk you through it.

Serving Knoxville, TN, and Beyond

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