All spay or neuter surgeries are performed by licensed veterinarians (DVMs), and every patient is given pain medication. However, it is important for you to understand that the risk of injury or death, although extremely low, is always present just as it is for humans who undergo surgery. Carefully read and understand the following before signing your name.
I, acting as owner or agent of the animal named above, hereby request and authorize a Humane Ohio veterinarian to spay or neuter the animal named on the above portion of this form.
I understand that the spay or neuter procedure presents some hazards and that injury or death may conceivably result because there is some risk associated with the procedure and the use of anesthesia.
I certify that my owned pet is up to date with their rabies vaccine and will provide proof in the form of a rabies certificate, or I understand that my animal will be given a one-year rabies vaccine at the time of the appointment for an additional cost. I understand that it may take up to two weeks from the time of the vaccination for maximum protection. I understand the inherent risks of failing to maintain current vaccinations and waive all claims arising out of or connected with the clinic visit for the spay or neuter procedure due to such failure. I understand, in particular, that if the animal develops kennel cough or other upper respiratory infections after surgery, I am responsible for treatment at my own cost.
I certify that my animal is in good health and has had no food since 12 midnight the evening prior to the spay or neuter (except puppies/kittens under four months old which are able to eat up to 6 am the day of surgery).
I understand that Humane Ohio has the right to refuse service to any animal to whom the spay or neuter procedure is deemed a health risk. I understand that some factors may increase surgical risk, including, but not limited to, obesity, pregnancy, heart murmur, geriatric, lactating, and diseases such as diabetes, epilepsy, FIV, Feline Leukemia and heartworms. Should complications surrounding the spay or neuter occur that require full service veterinary care, I understand that Humane Ohio is not equipped to offer these services.
I understand that Humane Ohio will perform a brief physical exam (if possible depending on the animal’s temperament) before the spay or neuter, but that Humane Ohio is not a full service veterinary clinic and may not be able to detect any or all existing health issues so it’s important that I see my regular veterinarian beforehand. Additionally, if my animal does not have surgery today, I am subject to a non-refundable $25 exam fee (taken from the spay/neuter deposit) for Humane Ohio’s time to examine the animal.
I understand that if my animal is pregnant, the pregnancy will be humanely terminated at the time of the spay.
I understand that if my animal has an open umbilical hernia or if he is cryptorchid (undescended testicle), it will be repaired at the time of surgery at an additional charge ($35-100). I understand extra pain medication will be strongly encouraged for these procedures, if not already selected.
I understand that excessive fleas will be treated at the veterinarian’s discretion with a 24-hr flea treatment (Capstar) for an additional charge. I further understand that there are risks to not maintaining my animal on flea preventative and that if the animal contracts fleas while at the clinic, I am responsible for treatment at my own cost.
I understand that if I do not pick-up my animal on the day/time given to me, Humane Ohio has the right to charge a daily boarding fee per animal.
I hereby release Humane Ohio, all veterinarians, technicians, assistants, volunteers, directors and employees from any and all claims arising out of or connected with the spay or neuter procedure or any adverse reactions from medication or vaccinations. I agree that I have not and will not claim any right to compensation from them, or any of them, or file action as a result of the spay or neuter or attempted spay or neuter of the animal named on this application or any consequences related thereto.
YOUR ANIMAL WILL RECEIVE A SMALL TATTOO ON HIS/HER UNDERSIDE TO SHOW THAT HE/SHE HAS BEEN SPAYED OR NEUTERED.
