Date(Required)

Owner’s Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Home Phone(Required)

Cell Phone(Required)

Work Phone(Required)

Pet’s Name(Required)

Species(Required)

Breed(Required)

Color(Required)

Age(Required)

Sex(Required)

Weight(Required)

I am responsible for the above described animal and have the ability to give you my permission to receive, prescribe for, treat and/or operate upon my pet. I acknowledge that the surgery or treatment contemplated is:(Required)

Canine Spay 30 – < (includes office visit and blood work) $350.00

** If in heat additional charge of $25.00 **
*** E-Collar and Pain Management will be an additional change ***

All charges including boarding cost shall be paid upon release from the hospital. If the pet is not picked up within 1-2 days after the time specified for return and if the doctor is not notified in writing of an alternate date within the thirty (30) day period, the animal will be considered abandoned and may be disposed of as doctor sees fit. It is understood that this does not relieve me from paying for all costs of service and use to the hospital including the cost of boarding.

*** You as the owner will be financial responsible for the blood work if for any reason the procedure can’t be done for abnormal blood work results.

After carefully reading the above, please sign the agreement.(Required)

Sign here

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Canine Surgical Consent Form – Spay Greater Than 30lbs

Make an appointment
with us today!

Make an appointmentwith us today!

Make an appointment
with us today!