I am the owner or the agent for the owner of the animal/animals listed above and have the authority to execute this consent. All of the horses to be worked on by Dr. Allen are described above or listed here or on another of these forms. I have been informed that there are certain risks and complications associated with any operation or procedure of this type. This has been explained to me and I further understand that during the course of the operations or procedures, unforeseen conditions could arise that may necessitate the performance of additional procedures and/or injury to horses or humans and I hold Dr. Allen blameless.

I authorize the use of appropriate anesthesia and pain relief medication as needed before, during or following the procedure. I understand that Dr. Allen is acting in the best interest of my horse/horse’s health and welfare and therefore give my permission for necessary dental procedures on this date and also for future dentistry work, realizing there are risks associated with the use of any medication. I will rely upon Dr. Allen’s judgment in the use of medication that he feels is needed to perform all of the necessary dental procedures as well as loading the horse/horses into the dentistry trailer, employment of the chute-stocks therein and unloading. The owner or agent realizes that there is also possibility of injury to humans and does not hold Dr. Allen liable.