Elective Surgery Consent

Owners Name	Pet’s Name	Animal Hospital/ Attending Clinician	Surgical Procedure (if applicable, MUST include which limb)

My Phone Number(s) Today

I have been advised as to the nature of the surgery described above and the risks involved. I authorize, Jefferson Nunley DVM, Jacob Goodin DVM or Erik Clary DVM to perform this surgery. I also understand that the above clinic/hospital (with assistance of the TVSS team as needed) will be using appropriate anesthetics (including epidurals & CRI’s per Dr. Nunley, Dr. Goodin or Dr. Clary) and medications needed to perform this surgical procedure and will be responsible for monitoring my pet.

Signature	Date	Witness

***If this form is not complete, the surgery will have to be rescheduled***

Yes, I give TVSS permission to use my pet’s picture/video & first name on TVSS social media sites

No, I do not give TVSS permission to use my pet’s picture/video & first name on TVSS social medial sites

TVSS

615-203-0317

info@tnvetsurgery.com

www.tnvetsurgery.com