Name *

First

Last

Email *

Pet's Name *

Pet's Age

Procedure your pet is receiving *

Phone number at which owner can be reached *

Additional Number *

When was the last time pet was fed? *

Anything else needed while pet is under anesthesia?

I am the owner (or authorized agent of the owner) of the animal described above, and have the authority to execute this consent. I understand that some risk always exists with anesthesia, even in apparently healthy animals, including the possibility of death. I have discussed my concerns with the veterinarian and understand that it may be necessary to provide additional medical or surgical treatment to my pet in the event of unforeseen circumstances. I realize that no guarantee, legal or ethical, can be made to me regarding the outcome of any procedure performed. I hereby authorize the use of anesthetics and other medications, as well as any such additional treatment, as deemed necessary by the veterinarian. I understand that hospital personnel will be employed in treating my pet. I have carefully read, and fully understand, this consent. * *

I have read and understand

Date *

Surgery Consent Form

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