Do you have an appointment already?
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Yes
No
**Please call us at (301) 483-7080 to schedule your appointment prior to completing this form.**
Filling out this form does not mean your appointment has been scheduled, only when your appointment is confirmed over the phone by our staff. You must call and leave a voice message, We will return the voice message as soon as possible and get you set up with an appointment.
Owner's Name:
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First Name
Last Name
Phone Number:
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Please enter a valid phone number.
Email:
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example@example.com
Address:
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Appointment Date:
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Month
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Day
Year
Date
Animal's Name:
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Microchip Number (if present/known):
Pet Breed:
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Pet Color:
Gender :
Please Select
Male
Female
Pet Age or Birthday:
Ex. 1/1/2024
Please mark all procedures to be performed today. For unlisted prices ask a receptionist:
Spay/Neuter $85-270
Rabies vaccine $15 (if proof of rabies vaccination has not been provided, this will be added)
DHPP vaccine $15
Bordetella vaccine $17
Leptospirosis vaccine $20 ( May require a booster in 4 weeks at your full-service vet)
Microchipping $45
Ear Cleaning $10
Nail Trim $10
Sedatives $14-50
Heartworm/Lyme/Ehrlichia test $45
E-collar (required for male dogs) $20-25
Umbilical hernia repair $40
Cryptorchid neuter (retained testicle not in scrotum) $60-180
Other
IV catheters and fluids are NOT INCLUDED in the price of spay/neuter surgeries except when deemed necessary. IV catheter and fluids are always recommended, particularly in older or sickly patients, but they are not required.
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Please Select
I WOULD like my animal to have an IV catheter for an additional cost ($55)
I DECLINE an IV catheter
We always recommend pre-op bloodwork for all our patients. We do not have the ability to perform same day bloodwork. If you would like to receive pre-op bloodwork and your procedure is today, please speak with a receptionist about rescheduling your procedure. Pre-op bloodwork is not required.
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Please Select
I DECLINE pre-op bloodwork
I WOULD like pre-op bloodwork. I will reschedule my procedure and pay an additional cost for it.
I have had bloodwork done ELSEWHERE and have provided a copy
Done at Spay Now prior to this Appointemnt
Please read and sign:
Spay Now will provide postoperative surgical rechecks for our patients for no charge during our regular clinic hours. If any medications are needed, there will be a nominal fee. Please call or email us (301-483-7080, spaynowsurgery@gmail.com) if you have any concerns after surgery. If you elect to take your pet elsewhere for post-operative care, we cannot reimburse you for any costs involved. If your pet is not currently on flea or tick prevention, there is a chance your pet may come into contact with animals also not on prevention and could contract fleas. In this event, I understand Spay Now is not at fault and that I may have to purchase flea/tick medication. I hereby declare that I am the owner, guardian, or responsible party for the animal listed above. I consent to and authorize Spay Now Laurel to perform the above listed procedures on my animal. I also consent for Spay Now to administer medications and/or ear cleaning, nail trimming, and/or grooming/bathing/matt removal as deemed necessary or prudent. While I expect these procedures to be performed to the best abilities of the veterinary and staff, I understand that with any vaccination, medication, anesthesia, or surgical procedure there are risks, including drug and vaccine reactions, bleeding, infection, or anesthetic complications up to and including death. I expect that reasonable precautions will be used to ensure the animal’s safety and well-being while in Spay Now’s care. I agree to release and hold harmless Spay Now Laurel, its agents, employees, and volunteers from all actions, causes of action, damages, claims or demands, which I, my heirs, executors, administrators, or assigns or the animal’s owner may have against the above referenced releases, for any and all damages, causes, or actions and injuries known or unknown, which may arise as a result of the surgery or treatment received by my animals. I have read and agree to the above:
Signature
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Date
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Month
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Day
Year
Date
Is your pet currently having any health problems?
Please Select
Yes
No
If yes, please describe:
Has your pet seen a vet recently for any health problems?
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Please Select
Yes
No
If yes, what was the diagnosis:
Is your pet taking any medications at this time?
Please Select
Yes
No
If yes, list what medication(s) and approximately how many days of it do you have remaining:
Is your pet taking any sort of steroid (prednisone, prednisolone, depo-medrol, etc) or NSAID (carpfrofen, rimadyl deramaxx, meloxicam, meloxidyl, etc) medication?
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Please Select
Yes
No
Are you able to make your pet take pill medications even if they do not want to take it?
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Please Select
Yes
No
Has your dog had any previous litters, c-sections, or other surgeries?Is there any chance your dog could be pregnant*?
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Please Select
Yes
No
If yes, please list:
Is there any chance your dog could be pregnant*?
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Please Select
Yes (*additional charges may apply)
No
Has your dog ever had or are they currently having any of the following (circle all that apply):
Seizures
Bleeding gums/bruising
Unexplained weight loss
Excessive vomiting or diarrhea
Excessive drinking/thirst
Excessive vaginal discharge
Please explain any marked above options:
Do you have any concerns about your pet? If so, please list:
With owner consent, certain procedures are recorded to be used as a training example for other doctors. They are not posted on any social media or freely available platform. Are you willing to consent to have your animal’s procedure recorded and stored internally?
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Please Select
Yes
No
Spay Now closes at 4 p.m. The latest time you can pick-up your animal is 3:30 p.m. At 3:30 p.m. clients who have not arrived are charged with a late fee of $50, and charged $25 for every 15 minutes they are late after 3:30 p.m. With your signature, you acknowledge that you have read and understood our late fee policy, and will be responsible for arranging transport for your pet in a timely manner.
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