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Surgery Authorization Form

Authorization for Medical and/or Surgical Therapy

I hereby authorize the doctor(s) at Rocklin Road Animal Hospital to administer medical treatment and/or surgical procedures as deemed necessary and such additional procedures as are considered therapeutically and/or diagnostically necessary on the basis on findings during the course of evaluation. I also consent to the administration of such anesthetics as are necessary. I hereby certify that I have read and fully understand the above Authorization for Medical and/or Surgical Therapy, the reasons why treatment is considered necessary, its advantages and possible complications, if any, as well as possible alternative modes of treatment, which were explained to me by the Veterinarian. I also certify that no guarantee or assurance has been made as to the results that may be obtained. Further, I assume financial responsibility for all charges incurred to patient, consent to release of medical information and authorize direct payment to Rocklin Road Animal Hospital. Signature is required at Rocklin Road Animal Hospital.
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