Online Forms

Anesthesia Consent Form

Protect your pet’s well-being during anesthesia with our informed consent form – their safety is our priority.

A pair of paw prints
A cat lying on the floor<br />
Online Forms

Anesthesia Consent Form

Protect your pet’s well-being during anesthesia with our informed consent form – their safety, our priority.

Pug dog on grassy area

Anesthesia Consent Form

Before proceeding with anesthesia, kindly take the time to thoroughly review and accurately fill out the anesthesia consent form for your pet’s safety.

I hereby authorize and direct the veterinarians of Central Kentucky Veterinary Services to perform the procedures and additional diagnostic and/or treatment procedures as deemed advisable for my pet. The procedure(s) has/have been explained to me and no guarantee has been made as to the results or cure. I understand that there may be risks involved in some of these procedures.

I agree to pay, in full, for services rendered, including those deemed necessary for medical or surgical complications or unforeseen circumstances. Any estimates or charges for the planned procedures are only approximations, and the final bill may be greater or less than these amounts. All services must be paid for when released. Some procedures require a deposit to be made before surgery.

Like you, our greatest concern is the well-being of your pet. A physical examination will be performed before anesthetizing your pet. However, many conditions including disorders of the kidneys, liver, heart & blood cannot be detected without blood lab screening. For this reason, we highly recommend pre-operative screening before sedating your pet. Please mark the appropriate options below:

**Items marked with asterisk are at an additional charge & not included in the price of the surgery

Other tests are available that are not included in the above choices. The tests selected above give the doctor a suitable overview of healthy patients. For those patients who are sick or in their senior years (above the age of 9), a full senior profile can be performed the day of the procedure with the doctor’s recommendation or at the owner’s request.


Our ability to minimize anesthetic and surgical risks and maximize patient safety is greatly enhanced by the completion of a physical examination and blood work prior to a surgical procedure. If you have any questions or concerns about the scheduled procedure, please do not hesitate to call or email at 859-987-6721 / customerservice@centralkyvet.com to discuss any aspect of the upcoming procedure.