Sedation Authorization
Date
04
/
06
/
2025
Client Name:
Email, just in case:
Contact Phone # for DATE OF APPOINTMENT:
Pet's Name:
At which location is your pet being sedated?
NAH Main St
NAH 39th Ave/Holistic
NAH Newberry
NAH Springhill
NAH Main St
Please choose one:
I authorize CPR in the event my pet stops breathing and/or his/her heart stops beating.
I do not authorize CPR in the event my pet stops breathing and/or his/her heart stops beating. I elect DNR (Do Not Resuscitate)
I authorize Newberry Animal Hospital, if deemed necessary, to sedate my pet and/or to do any other therapeutic procedure that professional judgement may indicate to be advisable for the patient's well being. I have been advised of the risk and nature of such medications with no warranty or guarantee given relative to the outcome.
Signature of Pet Owner/Client:
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