Spay/Neuter Canine Form

Spay Neuter Form Canine

Thank you for selecting our hospital for your pet’s surgery. In order to facilitate the admission process, please complete this document and sign it electronically prior to the morning of surgery.

Step 1 of 4

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Email(Required)

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Phone

Cell or Home Phone(Required)

Pet's name(Required)

Pet's sex(Required)

Male

Female

Breed (If unknown, so state)(Required)

Age range of your pet:(Required)

One year or younger

Older than one year

Pet's age in months(Required)

Pet's age in years(Required)

Do you request any other services be performed while your pet is here?

Physical examination ($59)

Heartworm blood test ($90)

Nail trim ($23.50)

Stool exam for worms ($73.80, $90 with Giardia)

Anal gland expression ($34)

Penn hip radiographs (Ask for fee)

Dew claw removal (Ask for fee)

VACCINES: Distemper, Parvo Virus, Bordetella, and Rabies vaccines are required. If done here, we can check our records. If done elsewhere, written verification must be provided or the vaccines will be administered.

DHP/Parvo Virus ($27.00)
With Lepto ($51.00)
Rabies ($37.00)
Bordetella ($33.50)

Note: $130 additional fee if dog is in heat, $168 additional fee if dog is pregnant, $100 additional fee if dog is over one year old. There is an additional fee for a retained testicle, please ask.

Intravenous Catheter and Fluids Notice:(Required)

The use of an intravenous catheter and IV fluids is an additional means to further decrease the risks associated with general anesthesia. The catheter is placed in the vein before anesthesia is initiated. This allows the doctors and nursing staff immediate access to your pet’s vein for administration of intravenous medications, which is particularly important in an emergency. Also, blood pressure tends to fall slightly during general anesthesia. IV fluids helps to maintain hydration and blood pressure, thus helping the kidneys and other organs to function normally during surgery. Your pet’s health and safety are our greatest concerns. IV catheters / fluids are now part of standard anesthetic protocols for many veterinary hospitals and are required at our hospital. To make an intravenous catheter and fluids affordable for all of our patients, the fee is $110.50.

I have read this notice and I understand it.

Pre-anesthetic blood test:(Required)

Because no surgery is without some risks, however small, it is advisable to perform a blood test prior to surgery to check the blood count, protein level, kidney, liver functions and ability to clot blood. Our hospital is fully equipped to perform these important tests and results will be available to the doctor prior to surgery. Should there be any indication that an abnormality exists, the doctor will contact you before proceeding or take those steps necessary to help insure the safe return of your pet.

I have read this notice and I understand it.

Pre-anesthetic bloodwork(Required)

Bloodwork has already been performed

Bloodwork will be needed today – Please ask for a quote

Where was the bloodwork performed?(Required)

On what date was the bloodwork performed?

MM slash DD slash YYYY

Post-op pain control:(Required)

Your pet is about to have a major abdominal surgery and will experience some pain after any surgical procedure. Humans are routinely given pain medications to ease their discomfort after surgery. Because animals often do not exhibit easily recognized signs of pain, they have been generally overlooked when it came to pain control. However, recent studies on animals and human babies have shown that post-operative pain medications will reduce the chances of post-operative complications, such as infections and poor healing, even in patients that showed no outward signs of pain.

The general anesthesia provides pain control while the patient is anesthetized but pain sensation returns within minutes of recovery. All patients receive an injection of an analgesic to control pain for the first 12-24 hours after surgery. This medication is safe, non-addicting and as potent as those used for humans. We will also be sending medication to go home for continued relief for the first few days following surgery.

I have read this notice and I understand it.

Microchip Identification: Each year, many pets are lost. Because these pets lack identification (collars and tags are often missing), many are never reunited with their owners. Worse, many are euthanized at animal shelters. To increase the chances that your pet will be reunited with you, we recommend the placement of a microchip. This is a small chip, encased in glass, about the size of a grain of rice, which is inserted under the skin. It is permanent and causes no reaction with the body. The chip number can then be registered with the national registry. In the event that your pet is lost and brought to an animal shelter or veterinary hospital with a microchip scanner, a scan is made, the chip number is recorded and the national registry is called to obtain information on the pet, such as owner’s name, phone number and any medical problems. Since this technology became available over ten years ago, thousands of animals’ lives have been saved. Insertion of the microchip at the time of surgery will be done for $63.00 (Note: This includes a lifetime registration paid to the national registry and we will pay this fee as a thank you for microchipping your pet today).

Microchip consent:(Required)

YES, I want my pet to have a microchip

NO, I do not want my pet to have a microchip

ELIZABETHAN COLLAR: Following surgery, some patients will lick or chew at the sutures, particularly when left alone. No one can predict which pets will do this. An Elizabethan Collar can decrease the likelihood of a pet being able to reach the surgical incision with his/her mouth. In you wish your pet to go home with an Elizabethan Collar, Please ask for a quote.

Elizabethan collar consent:(Required)

YES, I want my pet to have an Elizabethan Collar

NO, I do not want my pet to have a collar

Consent(Required)

Do not allow your pet to eat or drink on the morning of the surgery. If you have questions regarding fees for surgery, vaccines or services, please call.

I am aware of the above conditions and accept financial responsibility for all charges associated with my pet and understand that payment in full is required at time of discharge.

I have read this information and understand it.

Phone number where you can be reached this morning (VERY IMPORTANT!)(Required)

Time of the last meal your pet ate (approximate)(Required)

Does your pet have any medical problems?(Required)

Yes

If yes, please describe

In the last 48 hours has your pet experienced any of the following? Please check all that apply

Vomiting

Coughing

Lethargy

Abnormal stool

Sneezing

If you checked one of the boxes above, please describe the condition here:

Please list any concerns you have for today

Please list any medications your pet is currently taking AND when the last dose was given. If "none", so state.(Required)

Do you need any of the following? Check any box that applies. (All services will be done at the discretion of the doctor)

Heartworm prevention refill

Flea prevention refill

Miscellaneous refill

Additional information:(Required)

A flea preventative will be administered if fleas are found on your pet today – There will be an additional fee. Please ask for a quote

I have read this and understand it.

Signature(Required)

Today's date(Required)

MM slash DD slash YYYY

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