Sedation Consent Form

Provide consent for your pet’s sedation procedure at Victoria Veterinary Clinic. Please complete this form prior to your pet’s visit and ensure all medical history and concerns are noted.

Get Started

About Sedation Procedures

Sedation is sometimes required to safely and comfortably perform certain procedures such as examinations, imaging, biopsies, and grooming. Your pet will be monitored closely during and after sedation, and intravenous fluids may be administered to support blood pressure, circulation, and recovery. Additional diagnostic or treatment services can also be performed while your pet is sedated.

Complete the Form

Consent Form for Sedation

Date of Sedation *

radiology, lump(s): the

Patient Name *

Client Name *

Email *

Is your pet fasted? *

Is your pet on any medications? *

Medication Name

Medication Dose

Medication Last Given

Any additional signs of illness? *

If yes, please explain: *

Sedation Cost: $89.50 (Hospitalization fees may also apply)

Procedure to be Performed Under Sedation:

Examination — $104.50
X-ray — $189.50 (price may vary)
Shave Down — $85.00
Biopsy - Please discuss with our team for an estimate
Blood Work
Growth Removal - Please discuss with our team for an estimate

Would you like the growth sent for analysis?

No
Yes (additional fees apply)

Location of lump(s):

Other procedure(s):

Intravenous Fluids may be administered during anesthesia to help maintain blood pressure, increase circulation and help your pet recover more quickly.

Additional Options (Check accept or decline)

Pain Management - Cost $28.14

Accept
Decline

A liquid medication given once daily for 3 days to help reduce pain and inflammation.

Elizabethan Collar - Cost: $9.60-48.49

Accept
Decline

Prevents licking or chewing of the incision area.

Medical Shirt - Cost: $40.06-46.95

Accept
Decline

Prevents licking or chewing of the incision area.

Pedicure - Cost: $0.00-25.75

Accept
Decline

Nails are clipped while your pet is under sedation. **Cost will vary depending on the level of sedation the pet is under.

Vaccinations - Core vaccines: $104.50-134.50

I authorize vaccines
My pet is vaccinated
I decline vaccines at this time

Our clinic recommends all pets have up to date vaccines. This helps prevent the spread of infectious diseases.

I authorize the veterinarians and staff at Victoria Veterinary Clinic to perform cardiopulmonary resuscitation (CPR) (including chest compressions, intubation, and emergency medications) in the event of a respiratory or cardiac arrest. (Fees apply)

Accept
Decline

1.I authorize and direct the Veterinarians of the Victoria Veterinary Clinic to perform the services indicated above and/or do any other therapeutic procedures that in their judgment may dictate to be advisable for my pet’s well-being. The risks and nature of the procedures have been explained to me, and no warranty or guarantee has been made as to the result or cure. *

1.I authorize and direct the Veterinarians of the Victoria Veterinary Clinic to perform the services indicated above and/or do any other therapeutic procedures that in their judgment may dictate to be advisable for my pet’s well-being. The risks and nature of the procedures have been explained to me, and no warranty or guarantee has been made as to the result or cure.

2.I hereby authorize and direct the Victoria Veterinary Clinic to provide such additional services for my pet as they deem reasonable and necessary, including, but not limited to the administration of anesthesia and the performance of services involving pathology and radiology, and I hereby consent thereto. *

2.I hereby authorize and direct the Victoria Veterinary Clinic to provide such additional services for my pet as they deem reasonable and necessary, including, but not limited to the administration of anesthesia and the performance of services involving pathology and radiology, and I hereby consent thereto.

3.Fees must be paid before my pet leaves the clinic. *

3.Fees must be paid before my pet leaves the clinic.

Contact Information

I may be reached at the following number(s) *

Name *

Signature *

Clear Signature

Download PDF Form

Request an Appointment Today

Victoria Veterinary Clinic offers full-service veterinary care for dogs and cats in Regina, SK, as well as nearby areas like White City, Pilot Butte, Lumsden, Emerald Park, and East Regina. As a Fear Free Certified clinic, we focus on reducing stress while providing expert care in wellness, surgery, diagnostics, dentistry, and cat boarding. Ready to get started? Request an appointment below.

Request Appointment

Have a Question?



Location

Victoria Veterinary Clinic
628 Victoria Ave
Regina, Saskatchewan S4N 0R1



Contact

Phone: (306) 522-8802
Email: vvetclinic@gmail.com



Hours

Monday – Thursday: 7:30 AM – 7:00 PM
Friday: 7:30 AM – 6:00 PM
Saturday: 9:00 AM – 4:00 PM
Sunday: Closed
Statutory Holidays: Closed

Name *

First

Last

Email *

Phone

How can we help you? *

Website