I consent to the anesthesia services indicated and I authorize that it be administered by the physicians of Anesthesia Company, LLC, all of whom are credentialed to provide anesthesia services at this health facility.

Part of the process prior to your procedure is providing informed consent regarding the anesthetic which will be used. We encourage all patients to speak up and ask any questions they have about the anesthesia before the procedure.

certify and acknowledge that I have read this form or had it read to me; that I understand the risks, alternatives and expected results of the anesthesia service; and that I had ample time to ask questions and to consider my decision.

This form and your discussion with your doctor are intended to help you make informed decisions about the anesthesia options for your treatment. Your doctor will be happy to answer any questions you may have regarding anesthesia and provide additional information before you decide whether to sign this document and proceed with the procedure. 1.

I consent, authorize, and request the administration of such anesthetic or anesthetics (local to general) by any route that is deemed suitable by the anesthesiologist, who is an independent contractor and consultant.

Anesthesia Consent Form Page 1 of 2 Rev 3-31-2022 I authorize qualified providers of the Cottage Hospital Anesthesia Department to administer the following type of anesthesia that I have checked below. General Anesthesia: This produces an …

I hereby authorize and request the anesthetist to perform anesthesia as previously explained to me, and any other procedure deemed necessary or advisable as a corollary to the planned anesthesia. I consent, authorize, and request the administration of such anesthetic(s) by any route that is deemed suitable by the anesthetist.

I consent to the anesthesia deemed appropriate by my anesthesiologist. I acknowledge that I have read this form or had it read to me and that I understand the risks, alternatives, and expected results of the anesthetic plan of care.

ANESTHESIA CONSENT Form 38655-02 (10/21) MR (InD) Aztec Barcode 201213 PATIENT IDENTIFICATION 3. I understand that some people may experience awareness of some or all of the events of a surgery or procedure and be able to recall these events even though general anesthesia is provided. The risk of this occurring is increased in people who have

You, in consultation with your physician, have decided to undergo a procedure that requires anesthesia. Your anesthesia provider has explained your anesthetic options, medically acceptable alternatives, and the substantial and material risks and benefits of the proposed anesthesia.