I, the undersigned owner or agent of the owner of the pet identified above, certify that I am eighteen years of age or over and 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. My signature on this form indicates that any questions I have regarding the following issues have been answered to my satisfaction:

• The reasonable medical and/or surgical treatment options for my pet.
• Sufficient details of the procedures to understand what will be performed.
• How fully my pet will recover and how long it will take.
• The most common and serious complications.
• The length and type of the follow-up care and home restraint required.
• The estimate of the fees for all services.

While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that veterinary medicine is not an exact science and that no guarantee or warranty has been made regarding the results that may be achieved. I also understand that my pet’s medical condition may change for better or worse and the attending veterinarian(s) may add or change treatments to fit the needs of my pet’s care as long as it falls within the guidelines of the estimate that was provided to me.

I assume financial responsibility for the services rendered and provide payment via cash, credit card (not American Express), or check at the time my pet is discharged from the hospital. Should unexpected life-saving emergency care be required I elect one of the following: SEE ELECTIONS 1 & 2