Spay/Neuter Release Form If you prefer to print this form, click here. Date* MM slash DD slash YYYY Owner's Name* First Last Owner's Date of Birth* MM slash DD slash YYYY Pet's Name* First Species* Breed* Your pet's spay or neuter today includes:Pre-anesthetic examPre-op blood panel that must be submitted to the laboratory within 30 days prior to surgeryIntravenous catheter and fluidsAll anesthesia and surgery costsPain relief injection and pain medications to go homePlastic e-collarSterilization tattooCourtesy nail trimSterilization TattooWould you like the sterilization tattoo? Yes No The following items are recommended at an additional fee:FeLV/FIV Test (For Cats Only)* Approve Decline 4DX Test for Dogs > 1 yr (heartworm, tick borne diseases)* Approve Decline Microchip* Approve Decline Upgrade to Inflatable e-collar* Approve Decline Cold laser treatment to speed healing/decrease inflammation* Approve Decline Preanesthetic Electrocardiogram (ECG)* Approve Decline Spay-Neuter Surgery ReleaseI hereby consent and authorize the doctor to receive, treat, prescribe or operate upon this animal. Hospital policy requires that the total amount of the estimate be paid upon admission to the hospital. Any additional balance due or credit will be required to be paid in full or reimbursed upon release of the hospital. There is no attendant or veterinarian in the hospital after hospital business hours. I have read the foregoing and agree. When was the last time your pet ate?* Phone Number where you can be reached today*Consent* I agree to the Surgery ReleasePlease type your name acknowledging the above release.* Δ
