The Pet Clinic - Oregon Spay/Neuter Fund Program Consent Form

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Oregon Spay/Neuter Fund Program Consent Form

CANINE SPAY: $105 - $175
CANINE NEUTER: $95 - $155
****Canine extra weight charge: $1.00 - $2.00 additional fee per pound over 90lbs****

FELINE SPAY: $75
FELINE NEUTER: $60

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Date* This field is required.

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Client ID

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Client's Information* This field is required.

Owner's Name

Initials

Email

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Phone Number* This field is required.*If we call you & do not hear back within ONE hour, additional fees may apply or your pet may not be altered.

Area Code

Phone Number

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Pet's Information* This field is required.

Pet's Name

Species

Sex

Weight

Age

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Medications given within 30 days* This field is required.

Yes

No

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If yes please specify: (last dose given, dose, etc.)* This field is required.

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* Please have all records ready when you arrive or you may be asked to step out to contact your current clinic and/or reschedule if not prepared.

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Medical conditions/concerns (Please list any medical conditions/concerns) (initials)

Oregon law mandates the use of pain medications for ALL pets having surgery. All pets receive an NSAID in hospital. Dogs will receive an additional 3 days for males and 5 days for females of NSAID/pain medication to go home. Cats over 4 months will receive 2 days to go home. The fee for this required pain relief package is $15.00. (initials) *

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All pets with fleas will be treated at owner's expense. The fee is $14.50. *

All pets must be current on Rabies vaccine or receive in hospital today. The is fee is $12.78.

Please select the option that applies to your pet *

All pets who are aggressive will be charged a fee of $40.00 - $69.50. (initials) *
(cover cost of additional sedation, anesthesia medication, and exam if applicable).

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All pets MUST be fasted the night before. If pets vomits, they will be given injection for their safety. This injection is $50 - $90 (depending on weight) *

Non-Salem/Keizer residents will be charged an exam fee of $41.60 *
(proof may be required).

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Optional services available and recomended

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OR BLOOD SCREEN - $44.00 * *

Check internal functions to help ensure safety of your pet while under anesthesia.

* Fractious pets may need to be sedated in order to get sample.

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EXTENDED PAIN PACKAGE * *

Canine: Additional Opiate injection & Laser treatment ($34.70)
Feline: Additional Opiate injection & Laser treatment ($24.70)

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I.V. CATHETER AND FLUIDS - $61.00 * *
Anesthesia/Sedation lowers blood pressure and decreases blood flow to vital organs. This option decreases risk during surgery by giving a direct port to the vein in case of emergency.

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SUBCUTANEOUS FLUIDS - $32.00 * *
Anesthesia/Sedation lowers blood pressure and decreases blood flow to vital organs. Fluid administered under skin gives approximately 24 hours of hydration.

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MICROCHIP - $38.00 * *
This chip then holds your pet's identity for life. If your pet is ever lost or stolen veterinary practices and shelters scan for a microchip before adoption or euthanasia.

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E-Collar - $8.96 - $13 * *
(depending on size)

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BRAVECTO - $59.97 * *
(Flea and tick protection for 12 weeks)
* Canine: Oral
* Feline: Topical

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NAIL TRIM - $8.00 * *
* Standard nail trim price is $20.35

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Recommended Routine Care

By de-worming your pet you are protecting your family.

10,000 children alone are affected annually by roundworms transmitted by dogs and cats, 1,000 of who lose their vision as a result.

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CANINE DEWORMER PANACUR/VIRBANTEL/DROTAL
Treats for roundworms, hookworms, whipworms, and tapeworms
$8.36 - $40.38

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FELINE DEWORMER PROFENDER/CENTRAGUARD
Topical solution that treats for roundworms, hookworm, and tapeworms
$21.30

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Vaccines - CatsAdditional vaccines will have one OSHA charge of $4.28 added.

Fvrc2p/Felv - 3wk/1yr ($28.55)

Declined All

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Vaccines - DogsAdditional vaccines will have one OSHA charge of $4.28 added.

DHLPP/Corona - 3wk/1yr ($29.75)

Bordetella - 3wk/6mo ($14.21)

Influenza Combo - 3wk/1yr ($41.14)

Lyme - 3wk/1yr ($32.41)

Declined All

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Feral CatsEar tipped at no additional charge

Yes

No

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Do you want to license your dog with Marion County today?

New License Renewal (Tag #)

Your Birthday

I understand that I must pay separately by cash (you must bring extra change) or check at the time of pick up .

Year of Licensing? (1 year if this is your dog's first Rabies vaccine)

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I understand that all preanesthetic and anesthetic agents involves some risks, but I will not hold The Pet Clinic, and its employees in no way responsible under any circumstance, as it is thoroughly understood that I assumes all the risks. (initials) *

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Should an emergency arise and my pet needs CPR, * want CPR performed (Cost accruing $260 - $550).

(initials) * I will pick up my pet as agreed. If I fail to pick my pet when it is ready for discharge, I promise to pay an extra boarding and additional treatment charges. I also understand that, if I do not pick up my pet as agreed, my pet may be declared abandoned.

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Authorization Signature* This field is required.

Clear

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Date* This field is required.

Date