Did you call to make an appointment already?
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**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.
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):
Breed
Pet Color:
Gender:
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Please Select
Male
Female
Species:
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Please Select
Cat
Dog
Is your animal Spayed/Neutered("fixed"), or Intact? (We require most animals we see to be fixed before or during their visit)
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Please Select
Spayed
Neutered
Intact/Unaltered
All animals must have proof of rabies vaccination prior to surgery. Otherwise, they must be vaccinated for rabies while under our care at an additional cost.
Pet Age or Birthday:
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, but it is recommended, and strongly recommended for older animals.
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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
Procedure being performed:
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Example: Leg Amputation / Foreign Body / Mass Removal
Would you like a Biopsy? (Additional fee of $200)
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Please Select
Yes, please biopsy findings
No, I decline biopsy
Has your pet been seen by any other vet for this problem? If yes, please provide a copy of medical records if you have not already done so.
Please Select
Yes
No
Is your pet on any medications? If yes, please list what medications and how many days remaining?
**LIST STRAIGHT ACROSS ONLY TWO LINES**
Does your pet have any other medical conditions?
**LIST STRAIGHT ACROSS ONLY TWO LINES**
With owner consent, Spay Now records specific procedures for other doctors to use for training purposes. Photos are also captured pre and post-operation for our social media accounts. Do you authorize Spay Now to document your animal's stay for internal and external use?
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Please Select
Yes
No
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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Today's Date
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Month
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Day
Year
Date
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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