Surgical Consent Form

I understand that the administration of anesthesia involves some risk to my pet, including rare
reactions to medications and possible death. I consent to the use of medications as deemed
necessary by the attending veterinarian.

I understand that all procedures and surgery also involve some risk to my pet. The most
common risks include, but are not limited to, bleeding, nerve damage, and infection.

I also understand that no guarantees or assurances have been made regarding the outcome of
this procedure.

I understand that the doctors and staff at Haines Road Animal Hospital will use all reasonable
precautions against injury, escape, complications, and death.