Surgical/Anesthetic Options: Please initial your choice for each option.
Consent for Anesthesia and Surgery
I, the undersigned, am the owner or authorized agent of the pet listed below and am at least 18 years of age. I elect
to have this pet undergo the anesthetic and surgical procedure listed below, and declare that I understand the
procedure along with associated benefits and risks (up to and including death) as outlined above, and I have had the opportunity to have my questions regarding the procedure answered.