Village at Main Veterinary Hospital - Low Cost Spay/Neuter Program Consent Form

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CANINE SPAY: $110 (UNDER 40LBS) / CANINE NEUTER: $95 (UNDER 40LBS)

FELINE SPAY: $85 / FELINE NEUTER: $65

Spay 40-60lbs: $135 / Spay: 60-90: $170
(Over 60lbs will be charged $2 per pound)

Neuter: 40-60lbs: $110/ Neuter: 60-90 $150
(Over 60lbs will be charged $1 per pound)

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Date* This field is required.

Date

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Owner’s Name

First Name

Last Name

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Phone #

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Email* This field is required.

example@example.com

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Pet’s Name

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Species

K9

FELINE

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Sex

Male

Female

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Oregon law mandates the use of pain medication for ALL pets having surgery. All pets will receive the BRONZE pain relief package.

The fee for this REQUIRED pain relief package is: $15 Both K9 & Feline

* ALL PETS with live fleas will be treated at the owner’s expense. The fee is $15.00.
* ALL PETS 4 months of age or older, must be current on a rabies vaccine.
* PETS that require excessive restraint and/or additional medication due to aggression will be charged an aggressive handling fee of $40.00.

I understand the above mandatory requirements Client Initials * ( Client Initials)

COMP SURGERY EXAM COMP SURGERY EVAL HEALTHCARE MAINT. EXAM

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OR BLOOD SCREEN - $65.00 {Blood screen that tests liver and kidney function}**Fractious pets may need to be sedated in order to get sample**

ACCEPT

DECLINE

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GOLD PAIN RELIEF PACKAGE (OPTIMAL)K9 - Additional injection is given in-hospital & laser therapy treatment $69.00 Feline – Additional Opiate injection given in-hospital & laser therapy treatment $45.00

ACCEPT

DECLINE

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SILVER PAIN RELIEF PACKAGEK9 – Additional Opiates given in-hospital $49.00 Feline – Additional opiate given in hospital $25.00

ACCEPT

DECLINE

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IV CATHETER AND FLUIDS (OPTIMAL) $65.00 This option decreases the risk during surgery. Fluids administered IV. Anesthesia lowers blood pressure and decreases blood flow to vital organs.

ACCEPT

DECLINE

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SUBCUTANEOUS FLUIDS – $35.00Fluids administered under skin.

ACCEPT

DECLINE

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MICROCHIP – $46.00

ACCEPT

DECLINE

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E-COLLAR (CONE OF SHAME) - $11.00 - $16.00

ACCEPT

DECLINE

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NAIL TRIM - $8.00

ACCEPT

DECLINE

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Cats

Rabies (1yr/3yr)

Fvrc2p/Felv (3wk/1yr)

Feline Dewormer $22.00 - $26.00 (Dep. on weight)

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Dogs

Rabies (1yr/3yr)

DHLPP/Corona (3wk/1yr)

Bordetella (3wk/6mo)

Influenza-N2/N8 (3wk/1yr)

Lyme (3wk/1yr)

Canine Dewormer $15.00 - $37.00 (Dep. on weight)

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EAR TIP - FERAL CATS – No charge

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Medication given within 30 days

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If medication given within 30 days please specify:(last dose given, dose, etc.)

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Medical conditions/concerns

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Additional Treatments

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As Instructed my pet WAS NOT fed after 9:00 pm last night.

MUST INITIAL

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My pet WAS FED (MAY HAVE EATEN) AFTER 9:00PM LAST NIGHT and I realize this poses additional surgical risks and I accept these risks and any charges that may incur.

Clear

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I understand my pet will receive a tattoo to indicate alteration* This field is required.

MUST INITIAL

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Authorization* This field is required.

In the event of cardiac arrest while under anesthesia, I consent to and authorize the veterinarian to proceed with life saving measures CPR ($121.00)

DO NOT RESUSCITATE

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I understand that there are some risks under any anesthetic, but will hold Village at Main Veterinary Hospital in no way responsible under any circumstance. Should my pet begin having complications, I consent and authorize the veterinarian to immediately begin measures to treat these complications. I will assume all financial responsibility for these measures. I thoroughly understand the information on this sheet is correct and by signing below, I understand and accept the policies of the hospital.* This field is required.AUTHORIZATION

Clear

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Date* This field is required.

Date