Spay-Neuter Consent Form

Owner's Name*
First Last
Phone Number (ICE)*
Patient’s Name:*
Breed*
Age:*
Species*
- Dog
- Cat
Sex*
- Male
- Female

Please list any medications not prescribed by All Creatures Veterinary Services that your pet is currently taking, including over the counter medication.

PLEASE NOTE: ALL PATIENTS WILL RECEIVE A CAPSTAR UPON ARRIVAL IF FLEAS ARE PRESENT*
- I understand
ALL PATIENTS HAVE TO BE UP TO DATE ON ALL VACCINE*
- I understand
Additional Surgical Options:
Laser Therapy: One time treatment after surgery to promote wound healing and decrease pain/inflammation. The cost is $10*
- Yes, I ACCEPT
- No, I DECLINE
IV Catheter: All patients will receive an IV Catheter to help increase the safety of the procedure(s) if necessary. This will allow instant access for emergency medications in the event an emergency occurs.*
- I understand
Pre-Anesthetic Bloodwork: Pre-Anesthetic bloodwork is recommended to screen for existing disease that could be made worse by anesthesia or that could interfere with a pet’s recovery from anesthesia. Bloodwork is highly recommended if your pet is 7 years or older.*
- I understand
Please complete the mini panel of bloodwork you are recommending prior to surgery on my pet at the additional cost of approximately $110.00 depending on the patients specific needs.*
- Yes, I ACCEPT
- No, I DECLINE
OR
Please complete the full panel of bloodwork you are recommending prior to surgery on my pet at the additional cost of approximately $247.00 depending on the patients specific needs.*
- Yes, I ACCEPT
- No, I DECLINE
Pain Medication: All Surgery patients will receive a pain medication injection that is included in the price of their surgery. However, that price does not include additional pain medication to be sent home with the patient (which you, the owner, will administer). Depending on the patients weight the price will vary.*
- Yes, I understand there will be an additional fee for pain meds as recommended by the doctor.
E-Collar: It is important to make sure that your pet’s incision sight stays clean and undisturbed after their surgery in order to prevent infection. The main cause of infection occurs when your pet is consistently licking its incision sight. If we notice your pet is licking before it goes home, we will discontinue that by putting an E-collar on them. This is not included in the price of surgery, as all pets do not require an E-collar.*
- Yes, I would like my pet to be fitted with an E-collar if needed at the price range of $11.00 – $38.00 depending on the size of my pet.
- No, I would not like my pet to be fitted with an E-collar. I assume all post-surgery responsibilities for my pet and understand that infection is a possibility.
Microchip: Microchips are a form of identification that cannot be lost or stolen. The microchip that our clinic uses is injected under the skin of your pet. It is traceable by Google and by microchip readers at veterinary clinics or shelters. We recommend microchipping your pet during surgical procedures due to the large size of the needle used to implant the chip.*
- Yes, I would like for my pet to have a microchip at the additional cost of $52.
- No, I would not like my pet to have a microchip.
Pedicure: Would you like for us to do a nail trim on your pet while they’re under Anesthesia?*
- Yes, I would like for my dog or cat to get there toe nails.
- No, I would not like for my dog or cats toe nails trimmed.
understand that some risks exist with anesthesia and/or surgery and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure(s) is/are initiated. My signature on this form indicates that any questions I have regarding the following issues have been answered to my satisfaction:
- The reasonable medical and/or surgical treatment options for my pet
- Sufficient details of the procedures to understand what will be performed
- How my pet will recover
- The most common and serious complications
- The length and type of follow-up care and home restraint required
- The estimate of the fees for all services
I understand the above statement*
- I understand and agree
While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that veterinary medicine is not an exact science and that no guarantee or warranty has been made regarding the results that may be achieved. I agree to assume financial responsibility for the cost and provide payment via cash, credit card, or check at the time my pet is discharged from the hospital.*
- I understand and agree
Please select one:*
- Should unexpected life-saving emergency care be required and the hospital staff is unable to reach me, the staff has my permission to provide such treatment and I agree to pay for such services.
- Should unexpected life-saving emergency care be required and the hospital staff is unable to reach me, the staff does NOT have my permission to provide such treatment and I agree to pay for such services.
If I desire that my pet have supervision when this facility is closed, I elect to transfer him/her to a local emergency clinic where overnight veterinary supervision is available at my expense.*
- I elect
- I do NOT elect
I understand that additional charges of approximately $50.00 will apply if a female dog/cat is found to be pregnant or in heat. If such findings are not discovered before the spay procedure, I will be responsible for this charge as well as the rest of my bill at the time of service.*
- I have read and understand
As the owner of this pet, I hereby give my consent to veterinarians of All Creatures Veterinary Services to perform the above stated procedure.*
- I give my consent
Signature*
Date*
MM slash DD slash YYYY
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