Spay/Neuter Surgery Permission Form

Company

This field is for validation purposes and should be left unchanged.

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)

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)

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

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.