Fluoroscopy Anesthesia Consent

Anesthesia Consent Form for Fluoroscopy
IMPORTANT:
THIS FORM IS FOR
FLUOROSCOPY
ONLY

If your pet is scheduled for a CT SCAN, you MUST fill out the CT SCAN form instead.
CT SCAN CONSENT FORM
Has the pet fasted? (No food for 6 to 8 hours) *
Referring Veterinarian *
Referring Clinic Name *
Your first name *
Your last name *
Pet's name *
Species/Breed *
Sex *
Neutered / Spayed? *
Pet's age *
I am the owner or agent of the above-mentioned pet, and hereby understand, consent, and authorize the following procedure(s):
Please check the left hand box on each item below to indicate your consent for each. *
By clicking on the submit button, I certify that I have read and consented to all of the items above.
Image Consent
Signature *
Should be Empty:

Anesthesia Consent Form for Fluoroscopy