ABC Steri Booking Form 2021

IMPORTANT INFORMATION TO PLEASE TAKE NOTE OF

FORMS

All attached forms to be fully completed and all information to be as accurate as possible and sent back for processing to confirm availability for the day. Incomplete forms will delay the process. Once the application form has been reviewed we will provide feedback on the availability of the day or an alternative day if the proposed date is unavailable.

SURGERY COSTS
Dogs
Cost of the spaying/neutering is all dependent on the dogs size. The prices are listed below. All animals are weighed at the clinic in order to do the calculation of the anesthetic required. The sizing and pricing is as follows and to be marked clearly on the application form.

- Giant Breed (30kg+) Dogs - R1000
- Large Breed Dogs (20 - 30kg) - R900
- Medium Breed Dogs (10 - 19kg) - R800
- Small Breed Dogs (1 - 10kg) - R700

Cats
Cats are set at a standard price of R600
The prices listed above ( dogs and cats) are for the “normal” sterilization/neutering surgery and exclude any another medical condition that your pet may have. Any other “Common” medical condition such as you pet being on heat or pregnant will have additional costs as the surgery is more complex. These prices can be found on the booking form. Any other medical condition that we may come across other than that has been listed on the booking for ABC Steri be communicated to you and there will be an additional cost.

VACCINATIONS
Vaccinations costs is additional to sterilization.
· 5 in 1 plus Rabies R250
· 5 in 1 R200
· Rabies R50
If your pet is booked in for sterilization/neutering and you would like your pet to be vaccinated please indicate this on the booking form. Vaccinations are also offered to your other pets that are not being sterilized/neutered or have already been sterilized/neutered, you can just bring them to the drop off points and we would gladly assist with vaccinating your pets.

Get Me Known Micro Chips
R150

PAYMENT
Payment can be made by the following methods.
Payment must be made immediately when placing your booking online to secure your booking.

Option 1 - EFT
BANKING DETAILS
ABC Steri
Capitec Acc
1483290067
Reference - Pets Name and Owners Surname

OR
Option 2 - Direct Cash Payment into Bank Account
BANKING DETAILS
ABC Steri
Capitec Acc
1483290067
Reference - Pets Name and Owners Surname

DAY OF SURGERY
On the day of surgery please ensure that your pets are secure and under your control at all times until your pet has been securely placed in a cage as there are many animals on that day. ABC Steri cannot be held responsible for animals that are not under their owners control.

Cats that have their own carriers - owners are to be sure that the cage is securely closed and the cat is unable to escape.

CLIENT DETAILS
Name & Surname *

First Name Last Name
ID Number *
ID Number
E-mail Address *
e.g. sample@gmail.com
Contact Number *
Please enter a valid phone number.
Alternative Number *
Please enter a valid phone number.
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
How many Family Members are in your Household? *
How Many Family Members are in your Household that receive a income? *
What is the combined Family Income in your Household? *
How many Pets do you have? *
How many Pets have been Sterilized? *
Kindly explain your circumstances below? Start Typing*

PET DETAILS

ONLY 1 Pet Per Booking
Specify the Event Date you would like to book for.
Only the stipulated dates are available for bookings:

Booking Date:blanks*
PETS NAME & BREED *

Pets Name Breed
DOG OR CAT? *
MALE OR FEMALE? *
SIZE? *
What Colour is your Pet? blanks*
PREGNANT OR ON HEAT? *
PETS AGE *
HAS YOUR PET HAD A LITTER? *
IF SO HOW MANY TIMES HAS YOUR PET HAD A LITTER?
HAS YOUR PET BEEN VACCINATED AGAINST ALL MAJOR DISEASES INC. RABIES? *
DOES YOUR PET HAVE ANY EXISTING CONDITIONS FOR EXAMPLE DIABETES? blanks*
STERILIZATION COST Payment to be made 14 days before the Sterilization Date. BANKING DETAILS ABC Steri Capitec Acc1483290067 Reference - Pets Name and Owners Surname *
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Giant Breed (30kg+) Dogs
1,000.00 ZAR Quantity
Item subtotal: 0.00 ZAR

Large Breed Dogs (20 - 30kg)
900.00 ZAR Quantity

Medium Breed Dogs (10 - 19kg)
800.00 ZAR Quantity

Small Breed Dogs (1 - 10kg)
700.00 ZAR Quantity

Cats (Big or Small)
600.00 ZAR Quantity

Total

0.00 ZAR
ADDITIONAL SERVICES TO BE PAID CASH ON THE DAY OF STERILIZATION

INDEMNITY OF Animal Birth Control,

hereafter referred to as

ABC Steris / Rietkol Vet and Rooikoppies Vet

Animal Name and Surname
Our vets are registered and SAVC accredited, but it is important for you to understand that the risk of injury or death, although extremely low, is always present just as it is for humans who undergo surgery. Carefully read and understand the following before signing your name.

1. I, owner, or acting guardian of the pet named above, hereby request and authorize” ABC Steris” to perform an operation for sterilization of the animal named above.

2. Should my pet need or have to go to a vet subsequent to the sterilization, ABC Steris will not be held liable for any fees incurred.

3. Should your vet contact us about sterilizing one of his/her patients – you have signed the
application form that you can not afford private vet fees to sterilize, and we go purely on what is filled in on the application form. Therefore, any repercussions are between yourself and your vet and not ABC Steris and your vet

4. Signed by myself or an authorized person at the time of handing above named pet over for sterilization.
Applicant Signature & Date *

DATE __________________________________________________ Clear
DATE SIGNED blanks
Should be Empty:

IMPORTANT INFORMATION TO PLEASE TAKE NOTE OF