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Anaesthesia & Surgery Consent Form Template for Vets

A consent form for procedures under sedation or general anaesthesia: procedure, estimate, contact number on the day, options and owner signature. Adapt the wording to your local regulations.

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Clinic name
Address · Phone · Email
Anaesthesia & surgery consent

Patient & owner

Patient name
Owner name
Species
Phone
Breed
Email
Sex / neuter status
Date
Age / date of birth
Case / record no.
Weight (kg)
Veterinarian

Procedure

Procedure(s) planned
Estimated cost
Contact number on the day

Options discussed

☐ Pre-anaesthetic blood tests☐ Intravenous fluids☐ Pain relief to go home☐ Microchip☐ Other procedures while anaesthetised (please list)
Notes

Owner declaration

I am the owner (or authorised agent) of the animal described above. The procedure, its risks, the estimated cost and the alternatives have been explained to me and I have been able to ask questions. I consent to the procedure and to the anaesthesia or sedation needed. I understand that the veterinary team may need to carry out further treatment in an emergency and that I will be contacted where possible.

Owner / agent — name & signatureDate
Veterinarian — name & signatureDate
Template from WeVet — free veterinary resources

Frequently asked questions

Is this anaesthesia & surgery consent template free?

Yes. You can see the whole template on this page. Downloading it for Word / Google Docs or saving it as a PDF needs a free WeVet account.

Can I add my clinic's name and logo?

Yes. Download the Word version and edit it — the clinic details at the top are blank fields.

Is the wording legally approved for my country?

No template can be. Adapt consent and record wording to your national veterinary council and local regulations before using it.

Have a case in front of you?Ask WeVet — the AI assistant built for veterinarians. Differentials, treatment plans with calculated doses, drug info from trusted sources and SOAP notes.
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