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Spay/Neuter Surgery Permission Form
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Spay/Neuter Surgery Permission Form
Spay/Neuter Surgery Permission Form
Name
(Required)
First
Last
Address
(Required)
Street Address
Address Line 2
City
Province
Postal Code
Day-time Phone Number (no spaces or dashes)
(Required)
Appointment Date
(Required)
Pet's Name
(Required)
Cat/Dog (Mark only one box)
(Required)
Cat
Dog
Free-roaming cat (feral or friendly barn)
Male/Female (Mark only one box)
(Required)
Male
Female
Unknown free-roaming cat
Pet's Breed. For cats indicate short, medium or long haired.
(Required)
Pet's colour(s)
(Required)
Pet's age or date of birth
(Required)
If your pet has seen a veterinarian, provide the Clinic Name; enter "none" if no veterinary relationship exists.
(Required)
Surgical Consent
(Required)
The Ontario SPCA uses qualified staffing and veterinary-approved protocols for all procedures. It is important for you to understand that the risk of injury or death, although remote in an otherwise healthy animal, is always present just as it is for humans who undergo surgery. Carefully read and understand the following before agreeing to and submitting this form at the end.
Agree
Owner Consent
(Required)
I am the owner or agent of the pet named above and hereby consent to the procedures to be performed on my pet. I have the authority to execute this consent and am over the age of 18. I consent to and authorize the ovariohysterectomy (spay) or castration (neuter) procedure, understanding the risks involved and agree to pay all fees as outlined to me, prior to surgery. I acknowledge that I read and understand the English language and that this consent is being provided voluntarily by me. I either certify that my animal has been vaccinated within one year prior to this date or waive my right to protect my animal by having it vaccinated, or request recommended vaccinations at the time of surgery, understanding that it takes up to two weeks for vaccinations to protect my animal. I waive all claims arising out of or connected with related risks due to lack of vaccine coverage. I understand that the Ontario SPCA has the right to refuse service to any animal who does not fit the physical parameters outlined on the Ontario SPCA website or as described to me, or to which surgery is determined to be a health risk, and that there will be an administrative fee if the website’s preoperative instructions and physical parameters are not met. If unforeseen conditions arise which, in the judgment of the veterinarian, call for procedures or treatments other than those now being authorized, I authorize such procedures if reasonable efforts to contact me for further consent are unsuccessful. I agree to pay any resulting charges. A late fee of $15/15 minutes will occur if owner is not present at appointed discharge time. Owners of pets left after the agreed time and date shall be charged a boarding fee of no less than $35 per night. In the event that you fail to pick up your pet at the time appointed for discharge, your pet may be considered abandoned and will be dealt with in accordance with the abandoned animal policies established by the College of Veterinarians of Ontario. In the event of an emergency, the Ontario SPCA may need to provide transport of the animal to another facility, and as such there are risks associated with it such as the obvious like collisions etc. as well as potential post-operative developments during the actual transport that may need attention on route or upon arrival home. I understand that this clinic is not open after 4 p.m. or most weekends, and have researched the options for emergency treatment in my area, should my pet have life-threatening complications. I accept responsibility for obtaining emergency treatment as required. In consideration of the delivery of the services referred to in this document, I hereby release the Ontario SPCA, all volunteers, directors and employees from any and all claims arising out of or connected with the performance of this procedure or any adverse reactions from vaccinations. I agree that I have not and will not claim any right of compensation from them, or any of them, or file action by reason of such sterilization or attempted sterilization of such animal or any consequences related thereto.
Agree
I certify that my animal has no health concerns that I have not disclosed to you, and has had no food since midnight the evening prior to surgery.
(Required)
Agree
Other
Please explain any health concerns your animals has, or if it has been feed since midnight the evening prior to surgery:
(Required)
Pre-Surgical Bloodwork Consent
(Required)
The importance of having pre-surgical blood work performed on my pet has been explained to me. I understand that not having this done will increase the risks involved in anesthesia and surgery. I further understand that if I have had blood work done on my pet, it does not guarantee that my pet will not have an anesthetic/surgical/vaccine complication or reaction. I understand that some factors significantly increase surgical risk, including but not limited to, pregnancy, heat and disease.
Agree
Vaccinations Consent
(Required)
I understand that it is recommend my pet be up to date on vaccines before surgery. I understand that due to the nature of the environment no matter how careful staff are, my pet may be exposed to infectious disease. I am accepting this increased risk of infectious disease and will follow up with my regular veterinarian if this occurs. I understand that the Ontario SPCA is not able to support the treatment of any infectious disease that maybe be acquired by my pet while at the clinic. I understand that having my pet vaccinated under anesthesia is not ideal because it may delay our detection of an adverse vaccine reaction. I understand that I may need to follow up with a full service veterinary clinic in order to acquire possible boosters for my pet to be fully protected.
Agree
Pregnancy Consent
(Required)
I understand that if my animal is pregnant, the pregnancy will be terminated at the time of surgery. If my animal has an open umbilical hernia, it will be repaired at the time of surgery at an additional charge in accordance with our billing policies. If my male has an undescended testicle which can be located, surgery will continue at an additional cost.
Agree
Risk and Emergency Consent
(Required)
I understand that if my pet is deemed to be at a higher risk every effort will be made to contact me. I understand that all efforts will be made to keep my animal safe. Should extra sedation be required due to my pets aggressive behavior, I will pay those fees at the time of pick up. If my female is diagnosed with a pyometra and complications occur, I will not hold the Ontario SPCA and its staff accountable and understand that all action will be taken to keep my pet safe. I agree to pay any and all extra fees should my pet require CPR or any other emergency intervention.
Agree
PetLink Consent
I, the pet owner, hereby agree that by using the PetLink (Datamars brand) microchip to receive their lost pet services, as well as promotion communications from PetLink regarding their microchip and recovery services. By agreeing to receive PetLink communications, I agree to the Ontario SPCA providing my personal information specified herein to PetLink for the purpose of receiving such communications. I understand I may withdraw my consent at any time by using the unsubscribe mechanism provided to me in communications from PetLink. I may also contact PetLink c/o Datamars Inc. at 345 West Cummings Park, Woburn, MA 01801 781-281-2216 petlink@petlink.net. If not applicable, then do not select "Opt-in".
Opt-in
Select which services you would like your pet to receive at the time of their spay/neuter surgery:
Vaccines (check all that apply)
(Required)
Rabies $25
I have proof of a current rabies vaccination
DA2PPV - dogs only (canine distemper-adenovirus type 2-parainfluenza-parvovirus) $25
FVRCP - cats, indoor only (feline rhinotracheitis-calici-panleukopenia vaccine) $25
FeLV - cats, indoor and outdoor (feline leukemia vaccine) $25
None
Post-operative incision protection (check all that apply)
(Required)
Onesie - female cats or dogs $31
E-collar ("cone") - cats or dogs $17
Bitter spray - male and free-roaming cats only $17
I have my own
None of the above; I acknowledge that without it my pet may lick their incision leading to infection
Additional services (all animals receive nails trims at no charge) (check all that apply)
(Required)
Microchip $27
Hernia repair (umbilical) $25
Ear tip - mandatory for free-roaming or feral cats (no charge)
Other:
What other additional services are you interested in?
Do you wish to watch the video on how to care for your pet after surgery at this time?
(Required)
Yes
No
Discharge Instructions For Your Pet: This 6 minute video should be watched before your pet's surgery appointment so you are familiar with how to care for them afterwards. It is available on our website at all times should you wish to review it at a later date.
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