Surgery/Anesthesia Release Form

Surgery/Anesthesia Release Form

  • Pet Owner Information
  • Patient Information
  • I, the Owner or Authorized agent of the above pet, hereby give Buffington Veterinary Hospital and/or it's agents, permission for anesthesia and the following procedure(s). I understand that during the procedure unforeseen conditions may be revealed that necessitates and extension of the procedure(s). I consent to authorize the performance of such techniques as necessary in the veterinarinarian's professional judgement. I do hereby forever release Buffington Veterinary Hospital and/or it's agents from any and all liability arising from said procedure(s). All patients receive a physical exam prior to anesthesia.
  • Pet History
  • If none, please list "none"
  • Please explain
  • Elective Procedures
  • Please enter your full name.
  • Date Format: MM slash DD slash YYYY

Contact Us

805 Homer Rd
Minden, LA 71055

Phone: (318) 377-1430

Location Hours
Monday8:00am – 5:00pm
Tuesday8:00am – 5:00pm
Wednesday8:00am – 5:00pm
Thursday8:00am – 5:00pm
Friday8:00am – 5:00pm

Close daily for lunch 12:00-1:00PM