Rescue Cat Spay/Neuter Surgical Consent Form

DUE TO THE INCREASINGLY HIGH FEES FOR CREDIT OR DEBIT CARD PROCESSING, WE KINDLY ASK THAT YOU PAY IN CASH IF POSSIBLE. THANK YOU FOR UNDERSTANDING!

The Watertown Humane Society Spay-Neuter Clinic provides a lower cost spay/neuter option for pets owned by the community as well as animals who are part of rescue organizations. Surgeries will be performed at the Watertown Humane Society located at 418 Water Tower Ct. Watertown WI 53094. Drop off time for surgery is between 8-8:30am and pick up time will be communicated day of but it is typically 2-4pm the same day as surgery.

Spay/neuter surgery carries a one-time cost that is relatively small compared to the long-term benefits. Along with helping curb pet overpopulation, spay/neuter surgery allows pets to live longer, healthier lives. It also makes them less likely to spray and/or mark territory and eliminates heat cycles. Unsterilized animals often exhibit more behavior and temperament problems than those who have been spayed or neutered.

Please fill out a SEPERATE form for each pet you would like to be seen in our Spay/Neuter Clinic.

* Please note, a current rabies vaccination certificate is required for animals undergoing procedures at the WHS Spay-Neuter clinic. If your animal does not have a current rabies vaccination you will be required to purchase one at your appointment.

TNR (Outdoor Feral Cats):

WHS is saving lives through The Quirky Cat Program, our no-cost spay-neuter program for outdoor cats. Please visit: www.whsadopt.org/thequirkycatproject for more information. Please note, this program is only for those residing in the Town of Ixonia and the Town and City of Waterloo. Proof of residencey may be required.

* Monetary Donations are gratefully accepted!

The Quirky Cat program at WHS is making great strides in making a lasting impact on the animal population in our community, but that cannot continue without your support.

Rescue Name*

Contact First and Last Name*

Rescue Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Rescue Phone*

Rescue Email*

Rescue Website*

Cat's Name*

Estimated Age (approximate if unknown. Animals under 6 months of age do not need to be fasted prior to surgery but no food the morning of. All other ages should be fasted after 9pm the night before surgery. Water is ok for all.)*

Estimated Weight*

Age (approximate if unknown. Animals under 6 months of age do not need to be fasted prior to surgery but no food the morning of. All other ages should be fasted after 9pm the night before surgery. Water is ok for all.)*

Sex*

MaleFemale

Breed*

Domestic Short HairDomestic Medium HairDomestic Long Hair

Primary Color*

Has your animal experienced vomiting or diarrhea in the past 10 days?*

YesNo

Has this cat bitten anyone in the past 10 days?*

YesNo

Has your animal gone under anesthesia in the past and experienced any difficulties?*

YesNoUnknown

If yes, please explain:

Any previous vaccine reactions or allergies?*

YesNoUnknown

If yes, please explain:

I understand and agree to pay a $40 fee for a Feline Neuter and $80 for a Feline Spay*

YesNo

Feline Distemper Vaccine $10 Fee*

YesNo

Rabies $10 Fee*

YesNo

3 Year Rabies $15 Fee*

YesNo

FIV/FELV Heart worm Test $15 Fee*

YesNo

Flea/Worm Treatment Senergy (generic form of Revolution-active ingredient Seleamectin) $10 Fee*

YesNo

E-collar for after surgery. REQUIRED for females. Recommended for Males $5 Fee*

YesNo

Microchip Fee $10*

YesNo

I understand underlying conditions that may exist without anyone knowing about it and may not be observable during the brief pre-surgical exam.*

I agree

I understand underlying conditions that may exist without anyone knowing about it and may not be observable during the brief pre-surgical exam.*

I agree

I understand and agree to the information stated about regarding surgical risks*

I agree

I, being lawfully authorized to make decisions on behalf of the animal named/described above (the "Animal"), hereby request and authorize WHS, including its affiliates and each of their employees, volunteers,veterinarians and/or other agents (collectively,"WHS Parties") to recieve, transport, prescribe for, treat and/or administer vaccinations and/or perform an operation on the Animal.*

I agree

I certify that the Animal has not bitten anyone in the last ten (10) days.*

I agree

I understand that the operation I have elected presents some hazards, and that injury to, post-operative infection in, or death of, the Animal may conceivably result, for there is some inherent risk in the procedure and in the use of anesthetics and drugs provided for the procedure, as well as in any vaccines used. I understand general anesthesia will be administered to the Animal for surgery. I understand and accept these risks to the Animal.*

I agree

I understand the inherent risks of failing to maintain current vaccinations and waive all claims arising out of, or connected with, the performance of this operation due to such failure. I understand, in particular, that if the Animal develops kennel cough or other upper respiratory infections after surgery, I am responsible for treatment at my own cost.*

I agree

I understand that WHS and/or any WHS party has the right to refuse any service and/or procedure to any animal for any reason, including, but not limited to, situations where surgery is deemed a health or safety risk. Such refusal is at the sole discretion of the attending veterinarian.*

I agree

I understand that a pre-surgerical exam will be performed on the Animal when possible, but that there are times, in the attending veterinarian's sole discretion, when such an exam may only be performed after the Animal has already been sedated or anesthetized. I understand that the Animal will not receive pre-operative bloodwork at WHS. If I choose for the Animal to have such bloodwork, I understand that it must be performed at a full service veterinary clinic.*

I agree

I understand that some risk factors significantly increase surgical risk, including, but not limited to, pregnancy, heat, and diseases such as feline immunodeficiency virus ("FIV"), feline leukemia virus ("FeLeuk"), heartworms, obesity, blood clotting disorders, endocrine diseases, and senior animals.*

I agree

I understand that if the Animal is an acceptable surgical and/or vaccination candidate, surgical procedures and/or vaccinations will be performed regardless of the Animals gender and/or medical condition, including but not limited to, pregnancy. I understand that if the Animal is pregnant, the pregnancy will be terminated at surgery.*

I agree

If an unforeseen event/emergency situation occurs or a medical condition is discovered that requires urgent immediate medical treatment, I consent that the attending veterinarian may perorm such treatment, or transport the Animal to another veterinarian for the provision of such treatment at my expense, without seeking additional authorization or consent from me.*

I agree

I understand that my further consent will be required for non-emergency treatment EXCEPT in cases where the Animal has an open umbilical hernia, which may be repaired at the time of surgery at an additional charge of $25 without my further consent, and/or agree that if one or more of my male animal's testicles are not descended (cryptorchid) I will be charged $25-$50 per undescended testicle, depending on location. This will be due at the time of pick up.*

I agree

I understand that if I do not show proof of a current rabies vaccination, WHS will automatically administer a one year rabies vaccine to my animal.*

I agree

Surgery drop off is between 8-8:30am and pick up time will between 2-4pm. An additional $15 charge will be applied if picking up tardy.*

I agree

All pets must be leashed or in a carrier.*

I agree

All animals will receive a small tattoo on his/her underside to show that they have been sterilized. All TNR cats will receive a mandatory ear tip.*

I agree

Activity:

No bathing for a minimum of 14 days after surgery. If patient is discharged on the same day as surgery, prevent access to steps, climbing and jumping as best you can.

If discharged on the same day as surgery and is an outdoor cat, the cat should be kept to be indoors overnight where it is warm and dry.

Diet:

Day of surgery offer small amounts of food and water after 8 pm, however if your cat becomes sick to his stomach, discontinue food until the next morning. As long as he/she is able to keep food in and doesn't exhibit signs of illness, you can resume normal diet the day following surgery.

Medications:

Begin all medications on the day of discharge unless otherwise directed. Directions for medications are printed on each bottle. Please observe recommendations for giving with food if stated.

Incision Care:

Please check the incisions daily. Some redness and swelling is a normal consequence of surgery and healing. If the incision becomes painful, opens or discharges pus or blood, please contact your regular veterinarian for follow up care. A small amount of clear fluid may ooze from the incision and is considered normal. DO NOT allow your cat to lick, chew, rub or pull at the incisions. If he does, you must stop the behavior right away and begin using the e-collar. If you do not have a collar at home, please pick one up from the shelter or your local pet store at the earliest ability.

I understand and agree to follow the discharge instructions below to the best of my ability*

I agree

I understand the importance of keeping my pet's incision site dry and clean for the 14 days following surgery*

I agree

I understand that if my cat is attempting to chew, lick, or bite the incision, I will do whatever is necessary to prevent that behavior*

I agree

I understand that there are risks involved in any surgery and I will not hold the Watertown Humane Society responsible for any unforeseen complications*

I agree

I understand that if any complications from the surgery arise I am to contact my local veterinarian for care for my pet*

I agree

I understand that if my regular veterinarian is not able to see my pet, I will take my pet to the soonest available emergency veterinarian clinic*

I agree

I have reviewed the charges associated with the spay/neuter surgery and any additional medical care I wish to have performed and agree to pay in full (minus deposit paid) at pick up*

I agree

Signature (please use your finger if using a smart phone or mouse if using a computer to electronically sign:*

Powered by Jotform Sign Clear

*

Cat Spay/Neuter NON-REFUNDABLE Deposit - This deposit will be deducted from your final total the day of surgery. To review total charges, please see above or review on our website: www.whsadopt.org/clinic (If you are a no show or cancel the day of your appointment, your deposit will be forfeited)$25.00

Quantity

Total $0.00

Rescue Cat Spay/Neuter Surgical Consent Form

Applicant Information

Cat Information

Optional Additional Medical Consent

Pre Surgical AGREEMENT

Cat Take Home Instructions

Post Surgical AGREEMENT