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Spay-Neuter Surgery Release Form
Date
*
Date Format: MM slash DD slash YYYY
Owner's Name
*
First
Last
Owner's Date of Birth
*
Date Format: MM slash DD slash YYYY
Pet's Name
*
First
Species
*
Breed
*
Your pet's spay or neuter today includes:
Pre-anesthetic exam
Pre-op blood panel that must be submitted to the laboratory within 30 days prior to surgery
Intravenous catheter and fluids
All anesthesia and surgery costs
Pain relief injection and pain medications to go home
Plastic e-collar
Sterilization tattoo
Courtesy nail trim
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 Release
I 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 Release
Please type your name acknowledging the above release.
*