Surgical / Anesthesia Release Form

I am the owner or authorized agent for the owner of the animal described in this form, and I have the authority to execute this consent.  I hereby give the Doctors at Macon Road Veterinary Clinic and any authorized agents, staff, or representatives consent and authority to perform the following procedures or operations:

The nature of the operations or procedures has been explained to me, and I understand what will be done.  I have also been informed that there are certain risks and complications associated with any operation or procedure of this type.  They have been explained to me as well.

I further understand that during the course of the operations or procedures, unforeseen conditions may arise that may necessitate the performance of additional procedures.  I authorize the use of appropriate anesthesia and pain relief medication as needed before and after the procedure.  I have been informed that there are risks associated with the use of any medication.  I understand that hospital support personnel will be used as deemed necessary by the veterinarian.

By completing this form, I am the owner or the authorized agent for the owner of the animal described, and I have the authority to execute this consent.