772-336-8111
contact@kellysanimalhospital.com

Follow

Home
About Us
Services
Forms
Resources
- Blog
- Payment Options
- FAQs
- Our App
- Careers
Contact
Online Pharmacy
Book Appointment

Surgical Anesthesia Consent Form

Use this form to give permission for your pet’s upcoming procedure and help us ensure a smooth, safe experience.

lady cuddling grey cat

Peace of Mind for Your Pet’s Procedure

Pet Information

Pet's Name *

Contact Information

Owner's Name *

First

Last

Email *

Phone *

Additional Phone

Secondary Contact: *

First

Last

* This person has your authority to consent to medical decisions regarding your pet's surgical care in the event we cannot reach you.

Secondary Contact Phone *

Today's procedure is: (example: spay, lump removal, dental cleaning, etc.) *

Additional Services Desired While Patient Is Sedated

Please select any/all that you would like us to provide while your pet is sedated

Implant Microchip
Nail Trim
Clean Ears
Express Anal Glands
Sanitary Clip (rectum, genitals)
Remove Lumps (specify location of lumps below)
Other (specify below)

Please specify where the lumps are located *

Please specify the additional service(s) you'd like provided to your pet *

Authorization

I authorize anesthesia/sedation for my pet. The nature and risks of this procedure have been explained to me. I understand some risks always exist with anesthesia and/or sedation, and I am encouraged to discuss any concerns I have about those risks with my veterinarian before the procedure(s) are initiated. My signature on this consent form indicates that any questions have been answered to my satisfaction. *

I have read, understand, and authorize

Payment due upon services rendered. *

I have read, understand, and agree

I have read and fully understand this Anesthesia Consent Form *

Yes

Signature of Responsible Party *

Clear Signature

Date *

Name



Address

150 NW Central Park Plaza
Port St. Lucie, FL 34986



Contact Information

Phone: 772-336-8111
Email: contact@kellysanimalhospital.com



Hours of Operation

Mon-Fri: 8:00 AM – 5:00 PM
Sat: 8:00 AM – 4:00 PM
Sun: Closed



After Hours Emergency

Please call Veterinary Medical Center (24 Hour): 772-337-8570 or Pet Emergency of Martin County (24 Hour): 772-781-3302

© 2026 Kelly's Animal Hospital | Powered by PetDesk | Privacy Policy | Accessibility Statement

Follow