Cat Spay/Castration Release Form

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Dog Name*

Birthdate or Age

Breed

Surgery to be performed*

Spay (Female)Castration (Male)

Is your pet current on vaccinations*

YesNo

Has your cat been tested for FELV/FIV?*

YesNo

If no, we recommend a FeLv/FIV test*

Yes test $48.50No I do not want a heartworm test

Any coughing, vomiting, or diarrhea noted?*

YesNo

Has your pet eaten this morning?*

YesNo

Has your pet been ill or injured in the past 30 days?*

YesNo

Is your pet allergic to any medication?*

YesNo

If your pet is allergic to a medication, what is that medication?

We recommend a blood panel prior to surgery to help detect any internal problems that may not be evident upon physical examination.

Minimum Recommended for Any Animal: PCV/TP This test checks for anemia

Yes $16.25No

Base Panel up to 6 years of age Chem5/CBC. This checks blood levels and kidney and liver values.

Yes $81.00No

6-10 years of age Chem 10/CBC. This checks blood levels and a slightly larger chemistry panel.

Yes $97.50No

Over 11 years of age Chem17/CBC/Electrolytes. This checks blood levels, our most comprehensive chemistry panel, and electrolytes.

Yes $156.75No

If there are any deciduous (baby) teeth that have not fallen out, these will also be extracted while your pet is asleep. There will be a charge for each tooth. Extracting these teeth prevents future dental problems associated with crowded teeth. If you do not mark an option we will extract baby teeth if needed.

I accept extractions if neededI decline extractions

Additional procedure(s) done while your pet is under anesthesia? If so what?

Microchip and Registration

Yes, place a microchip while my pet is asleep $58.25No, I do not want a microchip

Post-surgical Laser Treatment to help alleviate pain and inflammation

Yes, I want laser therapy for additional pain control $12.25No, I do not want laser therapy

A long acting pain injection that lasts for 72 hours will be given to all elective feline surgeries with the exception on feline castrations. The cost for this injection is $32.50.

I am the owner or agent for the above described animal and have the authority to execute this consent and authorization of the above named surgery (s). I understand that during the performance of the procedure(s) unforeseen conditions may be revealed that necessitate an extension of the foregoing procedure(s), or even different procedure(s) as necessary and desirable in the exercise of the veterinarian’s professional judgement. I have been advised of the nature of the procedure(s), as well as the risks involved, and also realize that the results cannot be guaranteed.
I additionally authorize the use of appropriate anesthesia, pathologist examination of excised tissue as deemed appropriate by the veterinarian, and the administration of the medications, and understand that hospital staff will be utilized as deemed necessary by the veterinarian. I have read and understand this authorization and consent.

Signature of owner or agent*

Date of Signature

Date

Phone Number where we can reach you during the surgery*

Please enter a valid phone number.