Spay|Neuter Info Sheet

List up to 3 dates of your preference that fall on a Tuesday when you could take your pet to and pick your pet up from the vet for their appointment. Drop off times are 7:30-8:30 AM and pick up time is from 4-5 PM the same day. The pick up/drop off location is the vet's office which is Ward Veterinary Clinic located at 845 N Coley Rd, Tupelo, MS.

**Your first preferred date needs to be at least 2 weeks out from today.**

First Preference Date*

Date (MUST BE A TUESDAY)

Second Preference Date if First is not Available*

Date

Third Preference Date if First and Second are not Available

Date

Pet's Name*

Pet Owner*

First NameLast Name

Are the pet owner and pet itself permanent residents of Marion County, AL?*

Did you apply for our Pet Owner's Financial Assistance?*

Email (put no@email.com if you do not have an email address we can use to confirm your appointment details)*

example@example.com

Phone Number*

Please enter a valid phone number.

Owner's Birthdate*

Date

Species (Canine = Dog; Feline = Cat)*

Breed*

Gender*

Color*

Pet's DOB or Estimated Age*

Pets weight in lbs (est. is fine but required)*

For smaller pets, you can weigh yourself, then weigh yourself holding the pet. Subtract your weight without the pet from your weight while holding the pet for the pet's weight.

Medical History/Illness (if none or unknown just note that)*

Allergies (if none but NKA)*

What services are you interested in your pet receiving in addition to their spay/neuter? [Exam, bloodwork, dental, heartworm prevention, flea/tick prevention, vaccines (specify type of vaccine desired such as distemper parvo for dogs or FVRCP for cats, Bordetella, rabies, etc. We do not schedule anything accept spay/neuter and/or rabies vaccines unless you specifically list here and then an estimate will be requested from the vet before we proceed or agree on any additional payment arrangements]*

Other Surgery or Medical Needs

Answering Yes to any of the below questions does not disqualify your pet from service, it just means that we or the vet may reach out to you to make the appropriate preparations for your pet's visit prior to their appointment. Example 1: If your pet is not comfortable with being crated or kenneled you would be asked to stay with your pet until they're taken back for their procedure, leave for an hour, then come back to pick your pet up. Example 2: If your dog is not comfortable with strangers or poses a bite risk at all, you would be asked to muzzle your dog or make arrangements for a slight sedative before their appointment so they do not injure themselves or anyone else. Your payment will not be refunded if you have to reschedule due to failure to notify us of your pet falling into one of the below categories at least 7 business days prior to their appointment date and if you choose to reschedule it will be at your own expense at the veterinarian's regular service rate.

Do you acknowledge the above statement and agree to answer questions A through B below honestly?*

Yes, I acknowledgeNo, I do not acknowledge

A. Is your pet comfortable with being in a kennel or crated?*

YesNo

a(1). If no, do you agree to get your pet comfortable with being in a crate or kennel prior to their procedure? We do have crates available to borrow if needed.

YesNo

B. Does your pet pose any sort of risk to vet or their staff? (biting, etc.)*

YesNo

Upload current Rabies Vaccination Certificate and any other medical history.

By submitting this form you hereby release Hoof or Paw and the veterinary clinic where your pet's procedure is scheduled (hereafter referred to as "Veterinary Clinic"), their volunteers, employees, agents, and representatives from any liability for damage or injury caused by my pet(s) while on the premises of the veterinary clinic. I understand that Veterinary Clinic takes all reasonable precautions to ensure the safety and well-being of animals while they are under their care, accidents and unforeseen events may occur. By submitting this form I acknowledge that I am solely responsible for any actions or behaviors of my pet(s) while at Veterinary Clinic, and I agree to indemnify and hold harmless Hoof or Paw and Veterinary Clinic, their volunteers, employees, agents, and representatives from any claims, damages, losses, or expenses arising from such actions or behaviors. I further understand that the Veterinary Clinic reserves the right to refuse service to any pet exhibiting aggressive behavior or posing a threat to the safety of other animals, clients, staff, or property.*

Yes, I agreeNo, I do not agree

Signature*

Today's Date*

Date

Please verify that you are human*