Macon Road Vet
4398 Macon Road, Columbus, GA 31907

Surgical / Anesthesia Release Form

 I am the owner or authorized agent for the owner of the animal described in this form, and I have the authority to execute this consent. I hereby give the Doctors at Macon Road Veterinary Clinic and any authorized agents, staff, or representatives consent and authority to perform the following procedures or operations: The nature of the operations or procedures has been explained to me, and I understand what will be done.

I have also been informed that there are certain risks and complications associated with any operation or procedure of this type. They have been explained to me as well. I further understand that during the course of the operations or procedures, unforeseen conditions may arise that may necessitate the performance of additional procedures.

I authorize the use of appropriate anesthesia and pain relief medication as needed before and after the procedure. I have been informed that there are risks associated with the use of any medication. I understand that hospital support personnel will be used as deemed necessary by the veterinarian.

By completing this form, I am the owner or the authorized agent for the owner of the animal described, and I have the authority to execute this consent.