Horse Name

Owner/Authorized Agent

Owner/Authorized Agent Email Address

By signing this form, I acknowledge that I am the legal owner or authorized agent of the horse listed above and consent to the procedure(s) and anesthesia to be performed by TN Equine Hospital.

Surgical Risks: I understand that equine surgery carries inherent risks, including but not limited to infection, bleeding, delayed healing, complications related to anesthesia, and unforeseen reactions during or after the procedure. I acknowledge that the veterinarians and staff of TN Equine Hospital will use all reasonable care and precautions.

I understand.

Anesthetic Risks: I understand that anesthesia in horses carries significant risk, including cardiovascular or respiratory complications, adverse drug reactions, prolonged recovery, injury, or death. Appropriate monitoring and precautions will be used throughout the procedure. Any changes in my animal’s condition will be communicated to me as soon as possible.

I understand.

Recovery and Post-Operative Care: I understand that post-surgical complications may occur, and that proper aftercare and follow-up are necessary. I agree to follow all post-operative instructions provided by TN Equine Hospital.

I understand.

Financial Responsibility: I acknowledge responsibility for all costs associated with this procedure and any necessary follow-up care, regardless of outcome. Payment is expected at the time of service unless prior arrangements have been made.

I acknowledge.

Pre-Operative Bloodwork (Recommended)

Pre-Operative Bloodwork (Recommended): Pre-operative Bloodwork (CBC and chemistry panel) is recommended to help identify conditions that may affect anesthesia or surgery.

Questions Answered & Informed Consent: I confirm that I have discussed the proposed procedure(s), anesthesia, risks, benefits, alternatives, and expected recovery with the veterinarian. All of my questions have been answered to my satisfaction. No guarantees have been made regarding the outcome.

I confirm.

Emergency Authorization: If I cannot be reached, I authorize TN Equine Hospital to provide emergency medical treatment and make decisions in the best interest of my horse.

I authorize.

I have read and understand this form and voluntarily consent to surgery and anesthesia for my horse at TN Equine Hospital, acknowledging the associated risks. I hereby release Tennessee Equine Hospital, their agents, and representatives from any and all liability for said animal.

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Hospital Surgical & Anesthetic Consent & Waiver

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