Anesthesia Consent Form

The Anesthesia Consent Form is a specialized consent document focused exclusively on anesthesia-related risks, options, and patient preparation. While surgical consent forms include basic anesthesia acknowledgment, this dedicated form provides the thorough documentation that anesthesiology departments and ambulatory surgery centers require.

The form explains the different types of anesthesia (general, regional, local, sedation) with patient-friendly descriptions of what each involves. Patients acknowledge understanding of anesthesia-specific risks: allergic reactions, respiratory complications, nausea, awareness during anesthesia, and rare serious complications. The pre-anesthesia health screening captures information critical for anesthesia safety: previous anesthesia reactions, family history of malignant hyperthermia, airway concerns, GERD/aspiration risk, and obstructive sleep apnea.

NPO (fasting) instructions are documented with clear timelines and acknowledgment. The form also captures information about loose teeth, dental work, body piercings, and jewelry that affect anesthesia preparation. This template helps anesthesiology teams standardize their consent process and ensure all critical safety information is captured before the day of surgery.