Medical/Surgical Consent Form

Consent and Acknowledgement

I acknowledge that the name of the horse, the procedure, the limb and /or the location on the horse proposed to receive surgery is correctly identified above, and that I give my consent for surgery to be performed as identified above. I acknowledge that I am the owner of the horse identified above, or an authorized agent representing the owner. I hereby acknowledge that the veterinarian has explained to me my horse's condition, proposed treatment, alternative forms of treatment, the risks and possible complications in the proposed treatment plan, the chances of failure and major risks or complications associated with this procedure. These major risks or complications include, but are not limited to, infection, rectal tears, excessive blood loss, drug and blood reactions, loss of sensation, loss of limb function, paralysis, ocular dysfunction, unplanned injuries to organs, nerves or blood vessels, organ damage and possibly failure, heart attack, and sometimes death. If any unforeseen condition arises and additional surgery is deemed medically necessary during my horse's procedure, I request and authorize my veterinarian to proceed. I understand that the practice of medicine is not an exact science. No guarantees or promises can be made to me concerning the result of any procedure or treatment. My request and consent for this treatment is the result of discussions with my veterinarian. I understand the risks, I have had the opportunity to ask questions, and they have been answered to my satisfaction. Any tissue or body parts surgically removed may be examined, recorded, and disposed of by pathology or hospital according to its custom and practice.

In order for the procedure to be performed at the Equine Medical Center of Ocala, it is necessary for you to sign this consent form acknowledging that you understand that general anesthesia will be required to perform the procedure described above, that you understand the risks, complications. alternatives and benefits, and that you have authorized and consented to such procedure.

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