Veterinarian Surgery Release Form in Miami Beach, FL

Fields with an asterisk (*) are required. Please add "N/A" where necessary.

Owner*

Case No*

Address*

Street Address City State ZIP Code

Phone*

Email*

Patient*

Breed*

Sex*

Age*

Color*

Markings*

I, the undersigned, do hereby certify that I am the owner of the animal described above, that I do hereby give Dr. Javier D. Andreu, DVM, his agents, servants, and/or representatives full and complete authority to perform the surgical procedure described as*

and to perform any other procedure like sedation and or anesthesia for surgery or any other procedure. At his discretion, may be useful to promote the health of the above described pet, and I do hereby and by the presents forever release the said Doctor, his agents, servants, or representatives from any and all liability arising from said surgery/procedure on said animal.*

Signed*

Email

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