Anesthesia Consent Form

Due to the COVID-19 prevalence, we want to ensure your safety and that of our team. Please answer yes/no to these questions:

*Please note: Answering yes does NOT prohibit your pet from being seen if they are ill but allows us to put appropriate safety parameters in place for our team and doctors.

Do you, or someone in your household, have symptoms consistent with COVID-19, a fever, cough, or difficulty breathing?(Required)


Have you, or someone in your household, been exposed to someone who has tested positive for COVID-19?(Required)



MM slash DD slash YYYY

Time(Required)

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Pre-anesthetic bloodwork, required if your pet is over 7 yrs of age(Required)



Microchip(Required)



Laser Treatment During Recovery. NOTE: Therapeutic laser is used post surgically to increase circulation to the surgical site decreasing inflammation, swelling and pain. This helps promote faster healing times and decrease scar tissue development(Required)


Authorization for dental extractions(Required)



If you elect to be called prior to extractions and we are unable to reach you via phone, dental extractions will not be performed.

Full Mouth Dental Radiographs(Required)


Biopsy(Required)


Should my pet require cardiopulmonary resuscitation (CPR), including cardiac compressions, positive pressure respiration, emergency medications, or other heroic interventions, I request that the doctor(s) at Hales Corners Veterinary Clinic conduct/not conduct such medical care as indicated below. If I request such emergency procedures, I agree to be held responsible for veterinary services provided to my pet while staff members pursue treatment and try to reach me for further directions. Regardless of my pet’s recovery or survival, I agree to pay CPR fees in addition to other fees already identified by the practice and agreed upon by me. We will administer CPR treatment unless declined.


Please call us at (414) 425-2339 when you arrive for drop-off. A full estimate of your pet’s anticipated procedure with be discussed with you via phone with a surgical technician at this time. That surgical technician will then come to your car to retrieve your pet or ask you to meet them at the front door. Please ensure that your pet is on a leash and wearing a tight fitting collar or in a carrier







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