Consent Letter For Medical Procedure(s) Under General Anesthesia

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In this case, representing as the owner or authorized agent of the owner with full ownership right (further mentioned as a patient’s owner) of the pet described below:


for my pet (further mentioned as a patient). I understand that although all procedure(s) will be performed to the best of the abilities of the professional staff, no guarantee or warranty can be made regarding the results or cure, so I will not hold Groovy Vetcare Clinic, the veterinarians, or any staff liable if any undesirable circumstances occur. I have had opportunities to discuss with a veterinarian until I obtained satisfying explanations regarding indications, procedures, goals, risks, complications, prognosis, alternatives, and other circumstances related to the treatment for the patient, which I fully understand and agree with, such as:

  • Sedatives or general anesthesia for the patient are always associated with inherent risks, including complications or death, even in apparently healthy animals.
  • One or more legs shaved in order to place IV fluids occasionally need to be done as the veterinarian intends to maintain blood pressure, increase circulation, and allow rapid administration of injection drugs during and after the patient undergoes the
  • Aggressive measures such as resuscitation (CPR), endotracheal intubation, establishing IV access, and administering oxygen, IV

fluids, and medications, or other critical care to save the patient's life in the event that the patient stops breathing, has no heartbeat, or the patient experiencing any unexpected life-threatening situation that urgently required to be performed even if attending veterinarian is unable to reach the patient’s owner.

I understand and accept that the information I obtained before the anesthetic procedure was performed on the patient regarding the plans mentioned above could evolve and also differ from the final results after. It correlates to problems that may not be revealed until a thorough examination and diagnosis under general anesthesia are performed. I declare further that I am willing to bear all costs incurred to any estimated fees already identified and agreed upon by me, as well as other expenses that arise from undesirable circumstances from the risk of the procedures. And I will obey the Groovy Vetcare Clinic’s payment policies.


  • The minimum deposit is IDR 2.000.000, added to the total cost of the initial examination fee, treatment(s), diagnostic test(s), medication(s), and laboratory test(s) that have been done before the procedure. The estimated cost of the procedure provided is an estimation and may change according to the patient's condition during and after undergoing the procedure.
  • Payment in full is required at the time of patient discharge
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