Surgical/Anesthetic Options: Please initial your choice for each option.
Consent for Anesthesia/Sedation 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.