Cat Appointment Form

Appointment Date*
Age Days
Points
Rabies Due Date

MonthDayYear
Date
Date

MonthDayYear
Date
Owner Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have details about the cat you are scheduling? Eg color, breed, age, etc. If you are trapping and do not have details about the cat yet, choose "no."*

YesNo
Cat Name*
Gender*

MaleFemaleUnknown - TNR only
Date of Birth (estimate is okay)*

MonthDayYear
Date
Breed*
Color*
If you have any health concerns or information you'd like the vet to know about, please enter details here.

Choose services below. Packages include savings over the cost of the individual services. *

Community Cat Trap-Neuter-Release PackageIncludes spay/neuter with ear tip, rabies vaccine, topical flea/tick prevention and ivermectin injection.

$45.00

Silver Package - FemaleIncludes spay, rabies vaccine, FVRCP vaccine and oral dewormer.

$75.00

Silver Package - MaleIncludes neuter, rabies vaccine, FVRCP vaccine and oral dewormer.

$65.00

Gold Package - FemaleIncludes spay, rabies vaccine, FVRCP vaccine, oral dewormer and microchip.

$85.00

Gold Package - MaleIncludes neuter, rabies vaccine, FVRCP vaccine, oral dewormer and microchip. Cryptorchid (undescended testicle(s)) incur an additional $25 fee.

$75.00

Platinum Package - FemaleIncludes spay, rabies vaccine, FVRCP vaccine, oral dewormer, microchip and FeLV/FIV test.

$115.00

Platinum Package - MaleIncludes neuter, rabies vaccine, FVRCP vaccine, oral dewormer, microchip and FeLV/FIV test. Cryptorchid (undescended testicle(s)) incurs an additional $25 fee.

$105.00

Kitten Package - FemaleMUST BE UNDER 12 WEEKS OF AGE Includes spay, FVRCP vaccine and oral dewormer.

$60.00

Kitten Package - MaleMUST BE UNDER 12 WEEKS OF AGE Includes neuter, FVRCP vaccine and oral dewormer. Cryptorchid (undescended testicle(s)) incurs an additional $25 fee.

$50.00

Spay

$57.00

Neuter

$47.00

FVRCP Vaccine

$10.00

Rabies VaccineOne Year Vaccine

$12.00

FeLV/FIV Test

$30.00

Frontline PlusHelps prevent fleas and ticks for up to one month

$10.00

Microchip w/registration

$12.00

Health Certificate w/surgery

$20.00

Eye Enucleation Includes long-acting pain medication

$150.00

Tail AmputationIncludes pain medication and antibiotics if needed

$100.00

Leg AmputationIncludes any necessary antibiotics and pain medication. Price ranges from $300 - $400 depending on complexity. If there is a balance due after surgery, you can pay at pickup.

$300.00

Payment Processing FeeThis offsets the fees we're charged to accept payments online.

$3.00

Enter coupon

Total

$0.00

Since you did not select any services with rabies included, please upload a copy of your pet's rabies certificate which is required by law for animals over the age of 12 weeks. *

Cancelof
Health Certificate

In order to issue a health certificate, the information listed below is required. Both the shipper and the receiver will get a copy of the health certificate by email.
Name of person shipping cat*

First NameLast Name
Shipper address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Shipper Phone*
Please enter a valid phone number.
Shipper Email*
example@example.com
Name of person receiving cat

First NameLast Name
Receiver address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Receiver phone*
Please enter a valid phone number.
Receiver email*
example@example.com
CONSENT AND RELEASE

Feline Fix, Inc is a registered 501(c)3 organization that provides transportation to and from our partner vet in Columbia, MO. Feline Fix, Inc is not affiliated with Korn Surgical Services, LLC, or their employees or representatives.

I understand and agree that FELINE FIX, INC shall not be liable or held responsible by me in any matter whatsoever for, or in connection with, the procedure(s) to be performed on the animal(s) scheduled for surgery on and I hereby hold the Released Parties harmless from and against any and all liability and damages that may arise. I will take full responsibility, financial and otherwise, if the Animal(s) become(s) ill. The Released Parties shall not be held liable for any damages caused by any unforeseeable events including fire, vandalism, burglary, extreme weather, natural disasters, or acts of God.

I agree that FELINE FIX, INC may take, or permit others to take, photographs or video of me and/or my animal, and that they may use or authorize the use of the photographs or video of me and/or my animal in any way it deems appropriate to support their mission, including fundraising purposes.

SURGICAL RELEASE

I verify that I am the owner or authorized agent for the animal(s) listed on this appointment form. I authorize the use of anesthesia and other medications as deemed necessary by the licensed veterinarian and understand that hospital personnel may be employed in the procedure as directed by the veterinarian.

I understand that anesthesia and surgery have inherent risks and that even apparently healthy animals may have complications. I understand that if complications develop during surgery, the veterinarian will provide medical or surgical treatment as needed.

I accept responsibility for keeping the animal(s) warm, clean, and quiet for the week after surgery. I agree to keep trapped cats contained in a temperature-controlled space overnight and I will not release them until the day after surgery.

I understand that the surgery clinic is not open to the public. Should follow-up care or emergencies occur after surgery, I agree that it is my responsibility to get care through my primary veterinarian or emergency clinic. I understand that Feline Fix, Inc. and/or Korn Surgical Services, LLC will not be financially responsible for any care needed after surgery.

I HEREBY WARRANT THAT I (A) AM AT LEAST EIGHTEEN (18) YEARS OF AGE AND THE AGE OF MAJORITY IN THE STATE IN WHICH I RESIDE, (B) HAVE READ THE TERMS AND CONDITIONS, AND THE SURGICAL RELEASE CAREFULLY PRIOR TO ITS EXECUTION, (C) FULLY UNDERSTAND THE CONTENTS OF THIS AGREEMENT, (D) REALIZE THIS AGREEMENT IS AN ENFORCEABLE LEGAL DOCUMENT BETWEEN MYSELF & “FELINE FIX, INC”, AND MYSELF & THE TREATING VETERINARIAN "KORN SURGICAL SERVICES, LLC" AND (E) VOLUNTARILY SIGN THIS AGREEMENT OF MY OWN FREE WILL. BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD, AND AGREE TO THE TERMS SET FORTH IN THIS RELEASE.
Signature*

Powered by Jotform SignClear
Rabies Header
Date Signed*

MonthDayYear
Surgery Type 4
Surgery Type 2
Surgery Type 3
Frontline
FeLV/FIV Test
Microchip
Dewormer
FVRCP
Sex - Rabies Cert
Surgery Type
Rabies
Vaccine Date
Vaccine Expires
Surgery1
ET
Rabies
FVRCP
FelV/FIV
microchip
pyrantel
frontline
eye
tail
leg
Manufacturer
Serial #
Type
After Surgery Instructions
Vaccine

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

Should be Empty: