Free · Unbranded · Consent & legal
An admission consent form for anesthesia and surgery. It captures the procedure and estimate, fasting and medications, the client’s decisions on bloodwork, fluids and resuscitation, and what to do if something unexpected is found.
Unbranded: no logo or linksNo account neededPrint at 100% on US LetterUpdated
What’s on the form
Contact details, the planned procedure(s), date, veterinarian, and the estimate range the client received.
Last food and water, medications given today, and known allergies or prior reactions.
A plain-language statement that anesthesia and surgery carry risk, including rare serious complications, even in healthy animals.
Pre-anesthetic bloodwork and IV fluids (accept or decline) and resuscitation status: full CPR or do not resuscitate.
Call first, proceed up to a set amount, or do not proceed, with the phone number to reach the client on the day.
Optional services while under anesthesia, initialed acknowledgments, and client and staff signatures.
Staff-side vitals, pre-anesthetic findings, who cleared the patient, belongings, and discharge timing.
Fill in online
Every line on the form is editable right here. When you’re done, print it or choose “Save as PDF” in the print dialog. Everything stays in your browser.
Click any line to type, or add your logo. Nothing is uploaded or saved.
Using it well
An "approved up to $___" line avoids holding a patient under anesthesia while staff try to reach the owner.
Resuscitation status is a decision clients rarely expect. Asking at admission, calmly and for every case, is kinder than asking in an emergency.
Confirm the number the owner will actually answer that day, not the one on file.
Printing, editing, and what the form does and doesn’t cover.
Typically: the procedure, the estimate, an explanation of anesthetic and surgical risks, the client’s decisions on optional tests and treatments, resuscitation status, what to do if additional problems are found, and signatures. Your state may have specific requirements.
Practice policies differ. The form records the client’s decision either way, and the decline option notes that undetected conditions may increase anesthetic risk.
Do not resuscitate: if the patient’s heart or breathing stops, the team will not perform CPR. Full resuscitation means they will.
Yes. Fill it in online and print, or use it as a reference for your own form. Have your practice’s attorney review any consent language before adopting it.
2 pages, US Letter, landscape
A landscape anesthesia record built the way monitoring actually happens: pre-anesthetic checks and every drug on page one, then a 5-minute vitals grid, the procedure timeline, and recovery on page two.
2 pages, US Letter, portrait
A consent form for dental cleanings under anesthesia. Its key feature is the extraction decision: the client chooses up front whether to call first, approve extractions up to a set amount, or decline, so nobody is chasing a phone call with the patient under anesthesia.
1 page, US Letter, portrait
A one-page itemized estimate with low and high columns, totals, deposit, and an expiry date. Clients choose accept, decline, or a partial plan and sign, so the decision and the numbers are on the record together.
A starting point, not legal or clinical advice. VetStack’s forms are general templates. Requirements for medical records, consent, and controlled substances vary by state and practice, so review the wording with your practice’s attorney and check your state veterinary board’s rules before adopting a form as standard.