Feline Surgery Consent Form

Phone number where you can be reached today *

Owner’s Name *

First

Last

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Cell

Pet Information

Pet’s Name *

Gender *

Male
Neutered Male
Female
Spayed Female

Age *

Week / Month / Year

Breed *

Color *

Weight *

Last time pet ate *

am / pm

Procedure *

Do you have a second pet? *

you

Surgery

Female Spay : $76.00
Male Neuter : $60.00, Cryptorchid - Add $58.00
Ear punch : $0.00 (to indicate alter status)

Vaccination

Yearly Distemper Vaccination : $41.00 (Initial vax: $37.00)
Leukemia Vaccination : $47.00 (Initial Vax: $39.00)
Rabies Vaccination : $11.00 (every 2 years after initial booster)

Preventative

Dispense de-wormer (Yearly)
Kitten de-wormer : $15.00 (under 3 months)
Microchip : $45.00

We want to make your pet Facebook famous!

Do we have permission to share your pet's photo and story on social media, our website and other marketing materials?

**Biohazard Fee of $7.00 added to each invoice

Other:

I, being responsible for the above-described animal, have the authority to grant you my consent to perform the selected procedures upon my pet and understand that they do not get an exam, options for pre-anesthetic bloodwork, or IV fluids. You are to use all responsible precautions against injury, escape, or death of my pet, but you will not be responsible or liable in any manner in connection therewith as it is thoroughly understood that I assume all risks. I will be responsible for all fees and service charges, including legal fees associated with the treatment of my pet.

After having carefully read the above, I signed in agreement *

Clear Signature

Owner or Responsible Party *

Date *

Please download and complete the appropriate form following the links and bring it in with you when you visit us at the clinic! Or fill out our online form below!

Feline Surgery Consent Form

Pet Information