I, the undersigned, am the owner, or duly authorized agent of the owner, hereby consent for my veterinarian and veterinary staff to administer Anesthesia / Sedation and perform surgery and or a dental on my animal (pet). I understand that there are inherent risks with Anesthesia/Sedation and Surgery/Dental. These include (but not limited to): seizures, allergic reaction, coma, or in rare cases death. Anesthesia/Sedation reactions are rare but can occur in anyone undergoing anesthesia/sedation. I also consent to the Surgery and/or Dental procedure listed below and understand that surgery/dental complications are possible. These include (but not limited to):  infection, dehiscence (incision comes apart), fractured jaw, tooth root remnant remaining or recurrence of the problem. This consent will include any and all follow-up procedures for the same problem. If I have any questions or concerns, I will discuss them with my veterinarian prior to the procedure.