Surgical Release Form Surgical Release Form Owner's Name * Owner's Phone * Owner's Email * Pet's Name * Pet's Breed * Pet's Age * Pet's Sex * Has this pet received any food or water since 9:00 pm last night? Yes No What kind of food does your pet prefer? Please include brand and how much. * Please list any medications your pet is currently taking. Please indicate dosage size as well. Has this pet ever bitten, scratched, or shown aggression toward anyone in any situation? Please explain. I understand the explanation you have given to me of the nature and purpose of the treatment, the risks involved, and the possibility of complications. I acknowledge that no guarantee has been made to me as a result of this procedure. PAYMENT IN FULL AT THE TIME OF DISCHARGE IS EXPECTED I, being responsible for the above described animal, have the authority to grant you my consent to receive, prescribe for, treat and operate upon my pet. Owner's Full Name * Today's Date * Owner's Signature * signature keyboard Clear If you are human, leave this field blank. Submit
