Please keep this letter for your records Thank you for your interest in FCAR s Low Cost Spay/Neuter Clinic.

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1 Please keep this letter for your records Thank you for your interest in FCAR s Low Cost Spay/Neuter Clinic. This packet contains important information and forms to be read, filled out, signed, and returned to FCAR at least 1 business day prior to your appointment. These forms can be returned to us in several ways: Fax: info@franklincountyhumane.org Snail Mail: 30 Sunset Meadow, St. Albans, VT In Person: Tuesday through Saturday 11:00AM 4:00PM Help & Questions: ext 10 To secure your appointment all paperwork and payment is due. Late or incorrect paperwork will result in forfeiture of your appointment. If it is necessary to reschedule kindly notify the shelter at least twenty-four hours in advance by leaving a message on our ext 10 voic . All animals over 3 months of age are required by law to be current on rabies vaccine before being released from the Spay/Neuter Clinic. All animals of appropriate age will be vaccinated at a cost of $10.00 each, unless rabies certificates (NOT rabies/registration tags) are provided by you to FCAR prior to surgery. For the safety of your animals please withhold all food (this includes treats) after midnight on the night prior to surgery. Water is permitted in moderate amounts. Unless alternative arrangements are made surgical admission will be from 8:30-9:00AM and discharge from 3:30-4:00PM (same day). To inquire regarding the status of your pet on the day of surgery contact the FCAR operator ext. 10 between 11AM and 4PM as the clinic extension will be turned off. We do require a phone number that we MUST be able to reach you (or someone you have authorized) during your pets stay here in case of an emergency. Please review our surgical release and procedures forms, exclusions, payment and late pick-up policies before returning your forms. If you have any questions that have not been answered after reading this material please contact the spay/neuter voic at ext. 10 and we will contact you with an answer as soon as possible. The date of my appointment: Have you provided FCAR with a copy of a rabies certificate (if not being vaccinated at FCAR)?: Please keep this letter for your records

2 Hours/Emergency Release PLEASE READ CAREFULLY BEFORE SIGNING I understand (FCAR) is open to the public from 11 a.m. to 4 p.m. Tuesday through Saturday. FCAR is closed on Sunday and Monday. staff, not a veterinarian, are available during the hours noted above however, they may not be immediately available by phone at all times. is closed all other hours and holidays. Spay/Neuter clinic patients needing care after FCAR hours should be seen by their regular veterinarian or by an emergency clinic. Charges for services provided by an outside veterinarian or an emergency clinic will not be reimbursed by FCAR under any circumstances. low-cost spay/neuter clinic is only offering vaccinations and prescriptions at the time of surgery. FCAR is never available as a regular veterinarian for routine physical examinations, vaccinations, or for animal sickness or injury. advises clients to keep a copy of their pet s records on file for the future needs of their pet. Records are not available immediately upon request and clients are advised to allow 1-2 business days for record processing. charges for copies of patient records requested after the date services are performed. Clients requesting records will be charged $5.00 per animal/per request and all clients are required to pick up the records in person. Payment must be received before records are released. Signature agreeing to terms, staffing hours and emergency care Date

3 Post-Operative Instructions 1. No running, jumping, playing, swimming or other strenuous activity for 7 to 10 days. Keep your pet quiet. Keep cats in the carrier or box until he/she can stand alone. Check your pet frequently for the next 6 to 8 hours while it is waking up from the anesthesia. Pets must be kept indoors where they can stay clean, dry and warm. No baths for the first 14 days during the recovery period. Dogs must be walked on a leash and cats kept indoors to ensure proper internal healing. 2. Check the incision site twice daily. There should be no drainage. Redness and swelling should be minimal. Do not allow your pet to lick or chew at the incision. If this occurs, an Elizabethan collar MUST be applied to prevent it. These can be purchased at most pet stores or farm supply stores. 3. Appetite should return gradually within 24 hours of surgery. Lethargy lasting for more than 24 hours post-op, diarrhea, or vomiting are not normal and your pet should be taken to your regular veterinarian. Dogs may have a slight cough for a few days after surgery from the breathing tube in their throat during surgery. 4. Do not change your pet s diet at this time and do not give junk food, table scraps, milk or any other people food during the recovery period. This could mask postsurgical complications. 5. Keep young children away from pets for at least 48 hours after surgery. 6. We recommend your pet receive a post-operative examination with your regular veterinarian 7 to 10 days after surgery. Have the incision checked for complete healing, to remove any skin sutures, and to discuss additional needs, follow-up care and vaccination boosters. 7. If there are any questions or concerns directly relating to the surgery during the recovery period, please call Franklin County Humane Society at (802) during regular business hours and we will do our best to consult with the veterinary staff here during your pet's surgery. If there is an emergency after hours, contact your regular veterinarian or BEVS (Burlington Emergency Veterinary Service) at (802) Charges for services provided by an outside veterinarian or an emergency clinic will not be reimbursed by under any circumstances. 8. If your animal was given his or her first distemper vaccine he or she will need at least one booster injection from your regular veterinarian in three to four weeks. Franklin County Humane Society is not available to perform the booster. I have read and understand all of the Post-Operative Care Instructions. Printed Name: Signature: Date:

4 FCAR Release & Procedure Form 30 Sunset Meadow St. Albans, Vermont P: ext. 10 F: Owner Information Date: / / Name: Address: City: Zip: Phone: (home) (work) (contact phone day of surgery) Animal Information Name: Species: Cat Dog Sex: M F Breed: Color: Sex Age: **If your dog is female: Date of last heat cycle How many litters has she had? DOB of last litter Note: For their safety, animals must not be given food after midnight the evening before surgery. Please carefully read the following: I certify that my pet is in good health and has had no food since 12:00 (midnight) the evening prior to surgery. Required by law, pets ages 3 months and older must have a current Rabies vaccination. I understand if I m unable to provide proof of current Rabies vaccination in the form of a valid Rabies certificate, it will be administered to my pet at a charge of $10. It is recommended pets be up-to-date on all preventative vaccinations before coming to (FCAR). I realize FCAR Spay/Neuter Clinic is a high-volume spay/neuter service and the Rabies vaccination is the only vaccination required for admittance. I understand it takes up to two weeks for vaccinations to protect my animal. I assume all risks associated with owning and/or exposure associated with an unvaccinated or recently vaccinated pet. I certify that I own and assume financial responsibility for the above named pet and grant FCAR and its staff members or agents my consent to hospitalize, administer medications or tests, receive transport, prescribe for, treat and/or perform sterilization surgery upon the animal named above. I understand that modern techniques and trained staff will be used to care for all animals, and reasonable precautions will be used against injury, escape or destruction of the animal. I understand the operation presents some hazards and that injury to or death of such an animal may conceivably result, for there is some risk in the surgical procedure and the use of anesthetics and drugs in providing this service. It is thoroughly understood, its staff, and agents will not be held liable or responsible in any manner, and I assume all risks. I understand my female pet will receive a small tattoo on her underside, near the spay incision to indicate that she has been sterilized. I consent to the tattoo in order to prevent an unnecessary surgical procedure in the future. I further understand that if, in the course of treatment, a condition is discovered which requires medical attention or an additional procedure, the attending veterinarian may, at his or her absolute discretion, perform such a procedure. I consent to these procedures and agree to pay reasonable additional charges, if any. I will provide a phone number that I or someone that I authorize can be reached at while my pet is at the FCAR. All dogs must be wearing a fitted collar and be on a leash. All cats must be in their own carriers or crates, including cats from the same household. If cats are NOT in their own carrier or crate, a cardboard carrier will be provided by FCHS for an additional charge of $5. No exceptions. Please do not bring multiple cats in one carrier each cat MUST be in it s own carrier for safety reasons. Pregnancy If in the opinion of the attending veterinarian, the animal is an acceptable surgical candidate, sterilization procedures will be performed regardless of medical condition, including pregnancy and in-heat pets. There is an additional fee of $25 for in-heat/pregnant cats and $ for dogs, based on length of surgery time/complications. Fleas- If your pet is found to have live fleas, he/she will be treated at your expense to prevent infestations to other pets at FCAR. If your pet does receive monthly flea treatment, please fill in what product and when was the last dose applied. 1

5 Pets will be ready for discharge between 3:30 and 4:00 PM. I understand if my pet is ready and not picked up by 4:30 p.m. I will be charged a late fee of $20. Donations: is a private 501 (c) 3, non-profit organization that relies solely on donations from the public. The average cost of each surgery is $150. If you would like to make a donation to our Spay/Neuter Clinic, please indicate the amount here: $50 $25 $15 $5 Other Amount Thank you! Surgical Procedures Requested: Please check the services ones you would like for your pet today: Dog: Cat: Spay 25# $150 Neuter 25# $120 Spay $75 Spay 26-50# $170 Neuter 26-50# $140 In-heat/Pregnant $25 additional fee Spay 50-80# $190 Neuter 51-80# $160 Neuter $45 Cryptorchid Neuter (Inguinal only) $150- $190 based on weight Cryptorchid Neuter $75 Umbilical Hernia Repair $25 additional fee Umbilical Hernia Repair $15 additional fee Mature Spay (post heat/post litters/obese) $50-$100 additional fee due to length/difficulty of surgery and/or complications during surgery in female dogs with these pre-existing conditions. This includes VSNIP procedures as well since FCHS is not reimbursed for these incurred charges. VSNIP does not pay for pain medications and we require pain medications for all dogs and cats with the exception of cat neuter surgeries. The fee is $15 for dogs and $10 for cats. Vaccinations/Tests Requested: Please check the services you would like for your pet today while here for surgery. Because of our high volume, anything not checked at morning drop off will not be available. Nail Trim $5 Fecal Exam $10 De-worming medication for roundworms $5-15 Microchip (lifetime registration) $25 Dog Vaccinations: Cat Vaccinations: Rabies $10 Rabies $10 DA2PP (Canine distemper) $15 FVRCP (Feline distemper) $15 Bordetella (kennel cough) $10 Leukemia/AIDS Testing $25 Advantix/Frontline (fleas, ticks, mosquitoes) $22 ** Revolution (fleas, worms, mites) $10** **Single dose, good for 30 days Please read if indicated above: I request and authorize to vaccinate my animal. I understand vaccinations can cause adverse reactions in some animals. I hereby release from any claims arising out of or connected with giving these vaccines and/or applying topical medication. I understand payment in full is required prior to the time of admission/drop-off to. Any additional fees incurred must be paid at the time of pick-up. We do not accept checks. Payment of cash, money order, Visa or MasterCard is accepted. Total Charges: Payment Method: Cash Credit /Debit Card CHECKS ARE NOT ACCEPTED! By signing this form, you have read and understand the above and previously outlined procedure and surgical release forms and hereby release the from any claims arising out of or connected to surgical complications and/or procedures performed on your pet. Signature of Owner: Date: 2

6 Spay/Neuter Exclusions PLEASE READ CAREFULLY BEFORE SIGNING The mission of the Low Cost Spay/Neuter Clinic is to offer to the public a way to have their pets sterilized to help aid in the reduction of a fast-growing pet population. Each year numerous pets are found homeless, neglected, or abused and abandoned simply from the fact that there are too many. By having your pet spayed or neutered, you are not only reducing this unwanted pet population, but you are also reducing your pet's risk for life threatening illnesses such as a pyometra (severe uterine infection), complications from difficulty in birthing, mammary (breast) cancer, and prostate cancer. The Spay/Neuter Clinic is not a substitution for your regular veterinarian. We are unable to provide routine veterinary care with the exception of vaccines and screening tests found in your packet of information at the time of your pet's surgery. Our hospital in the FCAR is equipped for routine spays and neuters of animals in good health. It is recommended if your pet may have any type of medical condition to consult with your veterinarian as to what would be in your pet's best medical interest to ensure proper treatment. The veterinary staff reserves the right to refuse surgical services if, upon admittance to the FCAR, any medical issues or conditions are present in your pet that would greatly increase your pet's risk of surgical complications. Exclusions include, but are not limited to, obesity, age, thyroid or other metabolic diseases, seizures, anemia, pyometra, poor body condition, or recent illness or toxicity. If your female canine pet presents with signs of being in heat the morning of surgery, we will not perform her surgery. She will need to have her surgery rescheduled in two months in order to ensure proper healing. Female dogs that have recently had puppies must have been weaned from them (no nursing) for a minimum of 4 weeks (cats a minimum of 2 weeks) to allow body condition to return to normal. Signature agreeing to exclusions Date