Twin Lakes - Spay/Neuter Request Form

Please note that by filling out this form you agree you are being truthful in your answers. You understand that a pre-surgical exam will take place the morning of the surgery and you understand that if we deem your pet medically unfit for the surgery based on the criteria previously mentioned, we have the right to decline the surgery.

Pet's Name*

Pet's Color*

Are you currently a client with Twin Lakes Veterinary Hospital?*

I am a new client, interested in switching permanently to TLVHI am a new client, not interested in switching permanently to TLVHI am already a client with TLVH

What is your first & last name? (Include anyone else who may be picking up or dropping off your pet on the surgical date)*

What is the phone number you can best be reached at?*

What is your home address?*

What is your email address?*

example@example.com

Where is your current veterinary clinic? (If you are not a TLVH client)*

What species is your pet?*

CanineFeline

What is the sex of your animal?*

MaleFemale

How old is your pet/when is their birthday? (Note that pets under 4 months of age or above 6 years of age do not qualify for the spay/neuter program)*

What breed is your pet? Be as specific as possible.*

What is the approximate weight of your pet?*

Does your pet have any previous or chronic medical issues? This includes heart issues, seizures, allergies etc.*

Is your pet on any medications or flea and tick prevention?*

When was you pet vaccinated last?*

Has your pet ever had any reactions to medications or vaccines in the past?*

YesNo

(MALES) Do you know if both testicles have descended?*

YesNoNot applicable

(FEMALES) Has your pet gone into active heat? If so when was her last heat?*

(FEMALES) Has your pet every had a litter of kittens/puppies? If so when was the last litter?*

(CATS ONLY) Does your cat go outdoors?*

Indoors onlyOutdoorsNot applicable

I understand that pre-anesthetic bloodwork is recommended prior to any surgical procedure but that it is not required or included as part of the low cost program. Pre-anesthetic bloodwork is $135 + HST additional. If I wish to have pre-anesthetic bloodwork I understand that I will be required to schedule a time to come into the clinic with my pet 1-2 days prior to the surgical date.*

I would like pre-anesthetic bloodwork for my petI decline to have pre-anesthetic bloodwork done

I understand that due to the nature of a high volume spay and neuter program, my pet will not be receiving an IV catheter or IV fluids. If I wish to have an IV catheter or IV fluids I understand that my pet will be scheduled on a separate surgical date and will not qualify for the low cost/high volume program.*

I accept

I understand that TLVH does offer vaccinations at $30+HST extra charge per vaccine. If my animal has not been vaccinated, or is not up to date I understand that TLVH is not responsible for any risks associated with unvaccinated animals.*

I accept

I understand that I will be offered a cone collar or a surgical onesie for after surgery to prevent my pet from getting to their surgical site. These vary in cost from $15 - $45 + HST depending on my choice and my pet's size. I understand that I will be able to accept or decline these the day of surgery.*

I accept

I understand that I will be emailed consent forms to the email I provided to review, sign and bring in on the surgery date or email back to TLVH. I understand if I cannot print these at home I will be required to fill them out the morning of surgery.*

I aceept

I understand full payment for spay/neuter is required when the appointment is scheduled. I understand that if my pet has not been seen by TLVH prior to the surgical date my pet may fall into a different weight category than anticipated and I may owe more money at the time of surgery.*

I accept

I understand that any extras or add-ons will be paid for at the time of discharge from the surgery. (Vaccinations, microchips, cones, onesies etc.)*

I accept

I understand when the form is submitted we'll be contacted to schedule surgery & take full payment over the phone.*

I accept

We have a cancelation fee of $100 for dogs and $50 for cats (rebooking does not apply)*

I accept

Pre-surgical questionnaire