Online Forms

Surgery Consent/Release Form

Surgery Consent/Release Form

If further problems are detected while your pet is under anesthesia, how should they be handled?

Phone numbers where I can be reached today:


A small area on either foreleg may be shaved for placement of an IV catheter.

Should an emergency arise calling for procedures in addition to or different from those authorized, I consent to whatever emergency treatment is necessary. I also consent to the administration of anesthesia. I understand that complications including, but not limited to infection, cardiac arrest, and death could result.

The nature and purpose of these procedures, alternative methods of treatment, risks involved, and possibility of complications have been fully explained to me. I acknowledge that no guarantee or assurance has been made as to the results that may be obtained.

I understand that my veterinarian has referred me to Lone Star Dentistry & Oral Surgery for Animals out of trust and concern that my pet be provided the opportunity to receive advanced veterinary dental care. By signing below, I hereby authorize Dr. McCoy and/or Dr. Kocsis, and their associates, to examine and treat my pet. I agree to maintain my relationship with my regular veterinarian for health issues not related to dentistry. I also assume full financial responsibility for the care of my pet, including for all necessary services rendered for medical or surgical complications and otherwise unforeseen circumstances. I understand that full payment is due at the time of discharge.