Request edit access
Horse and Hound Surgery Authorization Form
Authorization for Anesthetic Procedure(s)
Sign in to Google to save your progress. Learn more
Authorization for Anesthetic Procedure(s) and/or Surgery Anesthetic and medical or surgical procedure(s) to be performed:  The most serious or common complications include: Low blood pressure, decreased respirations or heart rate, drop in body temperature, bleeding, healing complications, opening of incision sites, allergic reactions to medications, and though uncommon, anesthetic death.I, the undersigned owner or agent of the owner of the pet identified above, certify that I authorize the veterinarian(s) at this practice to perform the above procedure(s). I understand that some risks always exist with anesthesia and/or surgery and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure(s) is/are initiated. I accept that veterinary medicine is an inexact science and that no guarantee of successful treatment has been made.  I have read and understand the nature of the above procedures and give my consent to proceed.
Animals Name (If you would like this form to cover all animals within your rescue for future surgeries please put rescue organizations name here) *
Rescue Organization Name *
Authorized Signature - Full Name and Date (Entering information agrees to the following above) *
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy