I, the undersigned, do hereby certify that I am the owner (duly authorized agent for the owner) of <animal> described above. I do hereby give Davis Animal Hospital, veterinarians, agents, and/or representatives full and complete authority to perform the surgical procedure described as:

I understand the nature and purpose of the procedures, risk involved, and possible complications that could arise. I understand there are no guarantees or assurances of the outcome of said procedures. I understand that while the anesthetic procedure is tailored to each individual patient, NO anesthesia is without medical risk. No guarantees can be made legally or ethically to me of any procedure performed. I release Davis Pet Hospital, Inc and it’s associates from liability if something were to go wrong. Should an emergency arise calling for procedures in addition to, or different from those stated above that such procedures will be performed. I agree to pay in full for all services rendered including those deemed necessary for medical and surgical complications or other unforeseen circumstances.

Microchip being placed
Sign above