Macon County Veterinary Hospital Anesthesia/Surgical Release Form

Date*

Procedure (example: Spay, Neuter, Dental, Mass Removal, Sedation Nail Trim or Groom)*

Pet Parent Name*

First NameLast Name

Patient Name*

Best Phone Number to reach you at with updates*

Please enter a valid phone number.Format: (000) 000-0000.

TextPhone Call

YesNo

I UNDERSTAND THAT THERE ARE ALWAYS RISKS INVOLVED WITH ANESTHESIA. IF A MEDICAL EMERGENCY ARISES
THE DOCTORS OF MACON COUNTY VETERINARY HOSPITAL WILL DO EVERYTHING POSSIBLE TO SAVE MY PET. I
UNDERSTAND THAT ALL CHARGES MUST BE PAID AT THE TIME OF PATIENT RELEASE. IN ORDER TO MAINTAIN A
DISEASE FREE ENVIRONMENT, YOUR PET MUST BE FREE OF INTERNAL AND EXTERNAL PARASITES. IF YOUR PET IS
INFECTED, THEY WILL BE TREATED AT YOUR EXPENSE.

Signature*