FELINE SURGERY CONSENT FORM

Name:______Pet’s Name:______

Address:______Best Phone Number:______

E-mail (optional):______

Surgery:______Date______

PET HEALTH:

  1. Has your pet had an allergic reaction to a vaccination or medication? ______YES ______NO
  2. Is your pet currently taking any mediations? (Aspirin, allergy meds, ect.) ______YES ______NO

Explain:______

  1. Has your pet ever had a seizure? ______YES ______NO
  2. What illness has your pet had in the last 2 weeks? Coughing Sneezing Vomiting Diarrhea Weight Loss

Loss of appetite None Other:______

ADDITIONAL RECOMMENDED SERVICES:

PREANESTHETIC BLOODWORK: $56.00 ______YES ______NO

We recommend bloodwork for every pet before surgery/anesthesia. Animals can hide illnesses or disease well without showing any outward signs. Bloodwork can alert the doctor or any preexisting conditions that may be present in your pet. A blood panel can reduce the risk of anesthetic, surgical, and postoperative complications. It screens for kidney disease, anemia, infections, liver disease, and diabetes.

FELV/FIV TESTING: $30.00 ______YES ______NO

We recommend that your cat be tested for FELV/FIV if their status is unknown. These are viral infections that your cat may have and not yet be showing signs or symptoms.

ADDITIONAL PAIN CONTROL: $10.00 ______YES ______NO

Your pet will receive a pain injection while here for surgery today. It is recommended to take home additional pain medication for your pet’s comfort. This can help control postoperative pain and inflammation.

RCCP $20.00 ______RABIES $15.00 ______FELV/FIV $30.00 ______

MICROCHIP $38.00 ______FECAL $15.00 ______

REVOLUTION (FLEA/EAR MITE TREATMENT) $18.50 ______

E-COLLAR $17.00 ______YES ______NO

You have the option to purchase an e-collar to prevent your pet from licking and chewing the surgical site. Cats that have post incisional complications due to licking or chewing will need to be examined and receive medications at your cost.

Please read, initial, and sign (required) the following:

______If fleas are found on your pet while at the clinic we will administer a capstar (a 24 hour flea control) during their hospitalization for a mandatory fee of $7.00. Monthly flea preventative is recommended.

______I will pay a boarding fee of $25.00 per night if my pet is not picked up on the designated day. I also understand that my pet will not have someone at the clinic attending to them overnight. A pet that is not picked up within 72 hours of surgery is considered abandoned and will be released to proper authorities.

______I understand that my pet will not be discharged from the clinic if my balance is not paid in full. A $25.00 per night boarding fee will be charged until the balance is paid. Any bill not settled within 72 hours of surgery will be considered abandonment of your pet and they will be released to the proper authorities.

______I understand that there will be additional charges if my pet is found to have a hernia, be in heat, is wild or feral, has undescended testicles, is pregnant, or has a pyometra (uterine infection).

I hereby authorize Webberville Animal Clinic to surgically sterilize the above mentioned animal. To my knowledge the above animal is in good health. I understand that there are risks with any anesthetic or surgical procedure and are encouraged to discuss any concerns with the clinic staff. The clinic will provide every possible means of care to reduce any risks of complications for your pet. My signature indicates that I am financially responsible for this procedure and are aware of the possible additional charges discussed above. I agree to indemnify and hold harmless the Webberville Animal Clinic and the attending Veterinarian from and against any and all liability arising out of the performance of all procedures referred to above.

*We except cash and credit card, including care credit for payment. No checks please.

Pet Owner’s Signature ______Date______

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