Feline Spay Consent Form

Client Name*

Patient Name*

Patient Age*

Breed*

Sex*

Date of procedure*

Preferred Contact Number(s)*

Preferred Contact Method:*

Phone CallText

Is your pet currently on any medication?*

YesNo

If yes, please list medication and how often administered

Feline Spay Base Pricing

Ovariohysterectomy (female) - $350.00

Our base spay/neuter fee includes the following:

Pre-anesthetic assessment prior to anesthesia
Pre-anesthetic ECG screen
IV catheter and fluid administration
Gas anesthesia using isoflurane with respiratory, oxygen, and heart rate monitoring
An injection of an anti-emetic to prevent post operative nausea for 24 hours
Local block at surgical site to control post operative pain
An anti-inflammatory injection to control post operative pain for 24 hours
A narcotic administration to control postoperative pain lasting 96 hours
Surgery
Nail trim (if requested)

A current wellness exam performed here is required for all surgical procedures. If this is due at the time of the procedure the cost is an additional $78.00.*

I acknowledge that if my pet has not had a wellness exam within 1 year one will be performed before surgery

Please review each of the listed options and check yes or no for each one:

LASER

The CO2 laser seals as it cuts resulting in very little to no bleeding at the incision site. Since the nerve endings are also sealed they transmit less of the pain sensation. The healing time is the same whether using a laser or scalpel.

Laser Upgrade | $39.50*

YesNo

SEDATIVES

Sedatives can assist in keeping your pet quiet during its 2 week recovery period.

Sedatives for Home | $20.75*

YesNo

POST SURGICAL COLLARS OR BODYSUITS

It is important that your pet does not lick or chew at his/her incision until completely healed.

To assist with this we offer the following options:

Elizabethan Collar (cone) - $12.75Post-Surgical Recovery Bodysuit - $36.00

By declining any post-surgical protection, I acknowledge that I will be responsible for any fees incurred for medication or services due to my pet licking or chewing at the incision.*

Yes

MICROCHIP

If your pet does not already have one we can implant a chip at the time of surgery. Our chips come with a lifelong registration and help quickly reunite lost pets with their families

Microchip I $49.50*

YesNo

IV Fluids I $89.75

YesNo

I acknowledge that if my pet is 7 or older this will be performed

Yes

PRE ANESTHETIC BLOOD SCREEN

A physical exam will be performed on your pet prior to the surgical procedure. However, this may not identify all systemic or metabolic problems. For this reason, we highly recommend a pre-anesthetic screen for all patients. This is required for pets 7 years of age and older within 90 days of the procedure.

Pre Anesthetic Blood Screen | $179.50-$300.00 (pricing based on age)*

YesNo

I acknowledge that if my pet is 7 or older this will be performed*

Yes

I would like my cat's nails trimmed at no additional charge*

YesNo

Please note that if your pet is pregnant, in heat, pre or post heat, or does not have both testicles descended at the time of surgery, additional fees will apply.*

Yes, I acknowledge this

Please read the following and mark accordingly:

I understand that some risks always exist with anesthesia and surgery and that I am encouraged to discuss any concerns I have with the attending veterinarian about those risks to the procedure.*

Please initial above

I understand that the attending veterinarian will make every effort to contact me regarding treatment in the case of unforeseen emergencies and I acknowledge that life-saving procedures will be performed in the case of an emergency*

Please initial above

While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved. *

Please initial above

I also assume full responsibility for any additional expenses incurred after the surgical procedure is performed such as radiographs, re-check examinations, and additional surgery due to post-op complications. These are more likely to occur when there is a failure to comply with the aftercare instructions that will be provided on the day of surgery. *

Please initial above

If my pet needs to be hospitalized after hours, I acknowledge they will be unattended for a period of time between shifts as we are not staffed overnight.

PAYMENTS FOR SERVICES PROVIDED FOR YOU AND YOUR PET IS EXPECTED AT THE TIME SERVICES ARE RENDERED. Acceptable forms of payment include cash, American Express, debit, Discover, Visa, or MasterCard. We do not accept payment plans. For larger invoices, you have the option of applying for financing through Care Credit. It is a third-party form of financing that does not have finance charges so long as you pay off the balance within 6 months. Insured Pets: You are still responsible for payment on your account at the time of service. Insurance reimbursement is between the insurance company and the insured. Overdue accounts will be turned over to a collection agency.

I have read and fully understand the terms and conditions set forth above.

Signature*

Date*

Please remember to not feed your pet 8 hours prior to drop-off for surgery. Keep water available

*biohazard medical waste fee will be added to all surgical procedures.