Consent Form for HAPI Low-Cost Spay & Neuter Clinic

Consent Form for HAPI Low-Cost Spay & Neuter Clinic
Please complete ONE FORM PER PET.

Failure to supply one form per pet will result in the cancellation of appointments.

All pets must arrive in a seperate carrier/crate for their safety. Failure to adhere to this rule will be done so at your own risk and Hope for All Pets, Inc. can not be held liable in the event one of your pets injures themselves or each other.

This form is to be completed once your pet's appointment has be scheduled, payment is due upon completing of this form. Please be aware that we require a 7 day notice to for a refund, so we are able to fill your appointment slot.
Pet Owner First Name*
First Name
Pet Owner Last Name*
Phone Number *
Secondary Phone Number*
Physical Address*
Email Address
City*
State*
Zip Code*
Pet Name*
Dog/Cat*
Male / Female*
Age*
Breed*
Color*
Estimated Weight*
If you have a dog scheduled for an appointment, there will be an additional $20 charge due at pick up if your dog is 10 pounds, or more, than you have put above. If you need to get a weight on your dog prior to confirming your appointment, please let us know, we can make arrangements to do this for you. Please initial below stating that you understand and agree to this.
If you are scheduled for a cat appointment, please type N/A in the box above.
Does your pet have any health conditions that we need to be aware of? This includes, but is not limited to, anything that may cause a higher risk for surgery. We highly recommend your pet have a wellness exam with your primary veterinarian prior to surgery.*

YesNo
If you answered yes, please explain here:
The cost for your pet's appointment is $55 for cats and $80 for dogs. This cost is for their spay and neuter. At no additional charge to you, we administer a rabies vaccination (if age appropriate), an FVRCP vaccine for cats or DHPP vaccine for dogs, a microchip, and pain medication. If you wish to decline any of these services, you will need to do so the morning of your appointment on your check-in paperwork.*

FIV/FELV Test (cats only) $25Flea Treatment: $10 per cats, or $10-$20 per dogsHeartworm Test (dogs only) $10Nail trim: $5-$10, based on size/condition of nailsNone $0
If you would like to decline a rabies vaccination for your pet, you MUST bring a current rabies certificate (signed by your veterinarian) the morning of your pet's appointment. If we do not receive proof, we will administer a rabies vaccination to your pet if they are over 12 weeks of age, which will be determined by our attending veterinarian the day of surgery. A rabies vaccination is required by state law and cannot be declined without proof of current vaccination. Please note that a tag or appointment reminder is NOT legal proof.
Please initial above to state that you understand and agree to these terms.
I, being of a legal age and responsible for the animal described above, have the authority to grant Hope for All Pets, Inc., their staff members, volunteers, and attending veterinarian my consent to receive, transport, prescribe for, treat, and/or perform sterilization surgery upon the animal above. I understand that modern techniques and trained staff will be used to care for all animals and reasonable precaution will be used against injury, escape, or destruction of the animal. It is thoroughly understood that the Hope for All Pets, Inc., and their staff, volunteers, and agents and the League for Animal Welfare will not be held liable or responsible in any manner and I assume all risk. If in the course of treatment a condition is discovered which requires medical attention or an additional procedure, such as, but not limited to, a hernia repair or the administration of IV fluids, the attending veterinarian may, in his/her absolute discretion perform such procedure. I consent to these procedures. I understand that I may be charged for additional services if deemed necessary by the veterinarian. I further understand that as long as in the opinion of the attending veterinarian the animal is an acceptable surgical candidate, sterilization procedures will be performed, regardless of the animal's sex or medical condition (including, but not limited to, pregnancy I understand that the attending veterinarian can refuse to perform any procedure, on any animal, for any reason, and such refusal is at the sole discretion of the attending veterinarian. I understand payment is due prior to surgery. By signing below, I acknowledge that I have read the statement above and abide by its content.
Animal Transportation Consent, Waiver & Liability Release Section:

HAPI strives to provide a safe and convenient transportation to veterinary clinics for animal medical care, including but not limited to spay/neuter surgeries. However, I understand that dogs/cats can sometimes be injured, escape, or become ill during transportation and understand that every dog/cat reacts differently and that animals, by nature, are unpredictable. Therefore, on behalf of myself (and my personal representatives, heirs, executors, administrators, agents and assigns) I read, understand, and agree to the following:

  •I hereby waive, release, and discharge HAPI and its owners, agents, officers, employees, or volunteers from any and all liabilities that result in injury to, or the loss of my dog(s)/cat(s), or any other property of mine which arises in any way out of the transportation provided by HAPI.

•I hereby agree to defend, indemnify, and hold harmless HAPI, its owners, agents, officers, employees, or volunteers from and against any and all claims of any nature including all costs, expenses and attorneys’ fees, which arise in any way out of the transportation provided by HAPI.

•I understand that HAPI will be providing transportation for my dog(s)/cat(s). HAPI agrees to exercise reasonable care of my dog(s)/cat(s) during transportation. I acknowledge that allowing HAPI, its owners, agents, officers, employees, or volunteers to transport my dog(s)/cat(s) involves risks of injury to my dog(s)/cat(s) during transportation. I knowingly accept and assume all known and unknown risks in allowing my dog(s)/cat(s) to be transported.

•I recognize the risk of injury that accompanies transportation of my dog(s)/cat(s) and acknowledge that this release is being relied upon by HAPI to permit transportation of my dog(s)/cat(s) to and from any veterinarian’s office deemed necessary.

•I accept any and all conditions, rules, and regulations declared by HAPI, associated with the activities, use of the HAPI facilities and transportation, and hereby agree to comply with them.

•HAPI will take precautions to prevent dogs/cats from running away from their vehicles or property but dogs’/cats’ behavior cannot be perfectly controlled at all times. I will not hold HAPI responsible if my dog/cat finds a way to escape during care or during transportation.

•HAPI may, at any time, remove a dog/cat from transport, or refuse a dog/cat transportation, if the dog/cat exhibits behavior that could be harmful to the dog/cat, other dogs/cats, or staff, such as:

o   Aggression or overly dominant behavior;

o   High anxiety or fear;

o   Refusal of dog/cat to load into vehicle;

o   A condition or behavior rendering dog/cat generally not fit for transportation;

o   If, in the opinion of HAPI employee or agent, transportation is not in the best interest of dog/cat;

o   Dog/cat not presented in a proper traveling carrier/cage

•I understand that dogs/cats can sometimes be injured or become ill during transportation. I accept that HAPI is not in any way responsible for any injury, stress or illness my dog(s)/cat(s) may suffer while under HAPI’s care or while being transported by HAPI. I will not hold HAPI liable, financially or legally, for any physical, mental, or health issues that arise during or because of my dog(s)/cat(s) transportation by HAPI. This includes, but is not limited to: dog/cat bites, minor cuts and scratches, bone breakage, tissue damage, joint problems, stress, viral infections, or diarrhea.
All female animals, and some male animals, are given a small tattoo to indicate that they are spayed/neutered, which is a very common practice during these procedures. Please initial below that you understand and accept this requirement for surgery.*
I understand and agree that my payment is non-refundable without a 7 day cancellation notice provided. In the event a cancellation is needed, please message us on Facebook.*
Please initial above in agreeance to the terms.
Our veterinarian strongly advises that you purchase an Elizabethan collar (often called an "e-collar" or "cone") for your pet to wear for 7-10 days post-operation. This prevents your cat/dog from licking/irritating their incision site, possibly preventing infection, or more severe complications. Failure to provide an Elizabethan collar for your pet after surgery is done at your own risk.*
Please initial above to state that you understand and agree to these terms.
I understand that this is a high volume spay/neuter clinic, which means my pets will be in close proximity to other animals throughout their stay. I understand that HAPI will take precautions to prevent the spread of illness, but due to the nature of a high volume clinic, and the unknown health status of the pets in their care, I assume all risk and understand that HAPI is not liable if my pet were to fall ill.*
Please initial above to state that you understand and agree to these terms.
I understand that I am solely responsible for any post-operative care that my pet requires. In the event my pet needs emergency veterinary care, Hope for All Pets, Inc. recommends Advanced Animal Care 24-hour hospital, located at 2120 Pimlico Dr., Richmond. KY. *
Please initial above to state that you understand and agree to this statement.
Pet Owner Signature*

Clear
Today's Date*

MonthDayYear
Date
Please select a cat or dog option below, plus any add on services you also consent to and wish to pay for.
prevnext( X )
Cat Spay or Neuter
Surgery includes Rabies (if age appropriate) and FVRCP vaccines, if owner so elects.

$55.00



FIV / FELV Combo Test (Cats)
$25.00



Flea treat for Cats
Revolution topical applied. Lasts for one month.

$10.00



Dog Spay or Neuter
Dog spay or neuter includes a Rabies Vaccine (if age appropriate) and a DHPP vaccine if the owner so elects.

$80.00



Heartworm Test (Dogs)
$10.00



Flea treat for Large Dogs
50 lbs and over

$20.00



Flea Treatment for Medium Dogs
21-49 pounds

$15.00



Flea treat for Small Dogs
Under 20 lbs

$10.00



Nail trim - Basic
Basic nail trim covers cats and dogs with routinely groomed nails. Excessively long or difficult to cut nails will need to upgrade to the advanced nail trim option.

$5.00



Nail trim - advanced
This option is for large, unkempt nails that will be more difficult to trim.

$10.00



Donation
We lose money on nearly every surgery we do. We heavily rely on donations to continue offering these clinics to the public. Please consider making a donation today.

$5.00 Increase Donation by $5 Increments



Total

$0.00
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