Owned Animal Receipt of Service

Transcription

1 Owned Animal Receipt of Service Pet s Name: I understand that my pet must be fully vaccinated and that I must provide proof of vaccinations before my pet can be altered. If I do not have proof, the SPCA of Northern Nevada can vaccinate my pet at an additional cost. Printed Name: Signature: Please mark any additional services you would like us to provide in the section below. Services Requested Product Price Opted Bloodwork $45.00 Microchip $15.00 Nail Trim $5.00 Vaccines Price Opted Bordetella $15.00 DHPP (Parvo) $15.00 Rabies $15.00 Influenza* $30.00 (*Two vaccines at two weeks apart, $30 each) In the event our Veterinarian determines the following, we will call the owner and let them know what was observed and collect payment for the services rendered. Additional Fees Price Cryptorchid $65.00 In Heat /delicate tissue/ $30.00 obese/abnormal uterus Pregnancy $55.00 Umbilical Hernia $20.00 Printed Name of Owner: Signature of owner: Services Requested Product Price Opted Bloodwork $45.00 Microchip $15.00 Nail Trim $5.00 Vaccines Price Opted FVRCP $15.00 Rabies $15.00 In the event our Veterinarian determines the following, we will call the owner and let them know what was observed and collect payment for the services rendered. Additional Fees Price Cryptorchid $65.00 In Heat /delicate tissue/ $30.00 obese/abnormal uterus Pregnancy $55.00 Umbilical Hernia $20.00 Printed Name of Owner: Signature of owner: "FVR" for feline viral rhinotracheitis; "C" for calicivirus infection and "P" for panleukopenia (distemper)

2 Animal Release for Treatment Owner s Information: First Name: Last Name: Mailing Address: Zip Code: Best Number to Call: ( ) Alt Number: ( ) Address: I authorize the SPCA of Northern Nevada to obtain my pet s medical records from my previous veterinary practice or veterinarian. Authorized Person to pick up my pet: First Name: Last Name: Relationship: Contact Number: ( ) About Your Pet: Name: Species: Cat or Dog Breed: Gender: Female or Male Approximate Age: Color: Any known health issues in the past year? Is your pet currently taking any medications? Yes/ No If yes, please explain: Please read below and sign I,, hereby authorize the veterinarians and staff of the SPCA of Norther Nevada (and any affiliated practices) to examine, prescribe for, and/or treat my pet. I assume all responsibility for all fees incurred for the care of my pet (unless pre-arranged billing has been agreed upon). I understand that the SPCA of Northern Nevada will not provide any veterinary services outside of spaying/neutering my pet and that any other veterinary services must be provided by my full-service veterinarian. I understand that the SPCA of Northern Nevada is NOT a full service veterinary clinic and the only services provided to my pet are related to the altering of my pet. The SPCA of Northern Nevada Is not responsible for any occurring costs either related, or unrelated to the altering of my pet. I understand the services that were provided to my pet today and agree to pay all charges for the service rendered no later than at the time of pick up. Signature of Owner: Printed Name:

3 OWNED ANIMAL RELEASE FOR USE OF ANESTHESTIC AND STERLIZATION I am the owner or the authorized agent for the owner of the animal(s) described on the previous page and I have the authority to execute this consent. I believe my animal(s) to be intact and I am bringing them for sterilization surgery. If my animal(s) is/are found to be already spayed or neutered, I understand that I am still responsible for payment of all services required. I understand the SPCA of Northern Nevada is not a full- service veterinary clinic. Although it is not required, I understand it is suggested that I should take my animal(s) to my regular veterinarian prior to surgery to rule out health problems that could cause complications with anesthesia. I understand that extensive pre-surgical examinations are not provided and bloodwork analysis is not required for animals under the age of 7 years old. I also understand that if my animal(s) are uncooperative, stressed, aggressive, or unable to be handled in any way, it may be necessary to use sedation to preform pre-surgical check and I am financially responsible for the sedation. I understand that if my animal(s) have not been previously vaccinated, there are risks involved with potential exposure to other unvaccinated animals. I will not hold the SPCA of Northern Nevada liable for any diseases contracted or any other necessary treatment my animal(s) may subsequently require. I authorize the use of appropriate anesthesia and pain relief medications as needed before or after the procedure. I understand that there are certain risks and complications associated with the use of any medication. I also understand that there are certain risks and complications associated with any operation or procedure of this type, including the death of my animal(s). I understand that it is my responsibility to ask for further information about the nature of the procedure and any complications thereof. I further understand that during the course of the operations and/or procedures, unforeseen conditions may arise that may necessitate the performance of additional procedures at potentially an additional cost for which I am financially responsible for. I understand that support staff will be used at the veterinarian s discretion. I understand that if I am bringing a feral cat, the cat will receive an ear tip on the left ear to signify surgical sterilization. I hereby give the SPCA of Northern Nevada, affiliated veterinarians, and any authorized agents, staff, or representative s consent and the authority to perform surgical sterilization of the animal(s) and any additional procedures/operations that I have requested. I have been informed of all applicable costs for these procedures and understand that payment is due at the time that I drop off my animal(s). I also agree to permit the use of my name and photo(s) of me and/or my cat or dog, for publicity or promotional purposes, without liability or obligation to me. I understand by signing this release form, I have agreed to release my animal(s) for surgical sterilization with the SPCA of Northern Nevada. By the release of my animal(s) today I have read and been given a physical copy of the release form and post-operative instructions. I understand that I am giving my consent based on all information given to me and I am responsible for asking for further information about the surgical sterilization procedure and/or post-operative care for my animal(s). Signature of Owner: Printed Name:

4 PLEASE READ AND SIGN ALL SECTIONS Pet s Name: General Health Warning To the best of my knowledge as a responsible pet owner, my pet is healthy with no diagnosed allergies to vaccines and has had no recent occurrence of abnormal coughing, sneezing, vomiting, diarrhea, or runny eyes. I understand that by refusing blood chemistry to hematology testing on my pet, the risk of reaction to anesthetic is increased due to potential unknown pre-existing conditions. I understand that by testing blood, such conditions could be discovered, and a negative reaction to anesthetic prevented and/or surgery could be denied for safety of the patient. I understand that in any case where anesthetic is used, whether blood work is conducted or not, a reaction to anesthetic may occur that could potentially causes illness or be fatal. I understand that anesthetic is provided by a licensed veterinarian and my pet cannot leave the premises until he/she is ambulatory. I understand that there is always a chance of potential injury during surgical practice and any resulting or injury that is not of relation to the surgical procedure done is my responsibility. Signature of Owner: Printed Name: E-Collar Waiver I understand that my pet is being sent home with an Elizabeth Collar (protective cone, aka e-collar ) for my pet(s) to wear for the next days post-surgery. This is to reduce the risk of the surgery incision being opened due to liking or chewing. I understand that in any case when surgery is performed, dissolvable sutures may break down or be torn by my pet. I understand that if I do not use the cone for my animal(s), any damage to the incision done by my pet(s) is financially my responsibility and not that of the SPCA of Northern Nevada. Signature of Owner: Printed Name: In Heat or Pregnancy Surcharge In the event my female animal is deemed to be in heat by the attending veterinarian, I understand there will be an additional fee of $30. In the event my female animal is deemed to be pregnant by the attending veterinarian, I understand that there will be an additional fee of $55. I understand that although my pet may not be exhibiting external signs of currently being in heat or pregnant, they may in fact be in heat or pregnant. The surgery time may be lengthened due to increased blood flow to the female organs and the delicate state of the tissues. Although typically a female in heat may exhibit a swollen volva and vaginal bleeding, there are circumstances when these signs may not be observed. All fees are to be paid no later than at the time of pick up. Signature of Owner: Printed Name: In the event that my female is pregnant, I consent to have the pregnancy terminated and agree to pay the additional charge of $55 for this procedure. Signature of Owner: Printed Name: Cryptorchid (Undescended testicle(s)) Surcharge In the event my male animal is deemed to be Cryptorchid (one or both testicles have not descended into the scrotum) by the attending veterinarian, I understand there will be an additional fee of $65 that is to be paid no later than at the time of pick up. The surgery time may be lengthened due to the veterinarian having to surgically open the abdomen to locate and remove the undescended testicle(s). This additional charge covers the additional surgery time and materials. Signature of Owner: Printed Name:

5 SPCA of Northern Nevada 4950 Spectrum Blvd Reno, NV (775) ext. 202 OWNED ANIMAL POST OPERATIVE CARE 1. Pick up times: Vary, clinic staff will call; pick-ups can be from noon-4pm 2. Animals had a surgical procedure today a. Give pain medications as directed b. For concerns about the medication, call us immediately 3. Monitor incision for swelling, discharge and redness a. E-Collars need to be worn days b. No licking or chewing at incision, no bathing, swimming, hosing down c. No jumping, running, rough-housing for 7-10 days d. Short walks on leash are fine e. Cats need to stay indoors for healing process 4. Sutures are dissolvable and will do so over the next few weeks a. Keep incision dry and clean 5. Feed lightly the night of surgery (half of normal feeding), allow access to water 6. Behavior is important for recovery a. In case of lethargy, decreased appetite or abnormal behavior consult regular DVM 7. If your animal received vaccinations today, watch for a. Facial swelling, vomiting/diarrhea, local swelling at site of injection, lethargy or anorexia b. Call regular DVM/ emergency clinic as soon as signs appear I understand that if my animal licks, scratches or causes abrasion at the incision site that this could result in another surgical procedure and prescription antibiotics for which I will be financially responsible. I will not hold the SPCA of Northern Nevada Clinic responsible for the repercussions if my animal is licking the incision site if I decline to use an E-Collar. I understand that my animal will need to wear the E-Collar at all times when I am unable to directly supervise him/her to prevent a potential infection. I understand that I am responsible to seek medical attention for my animal from my regular veterinarian or a qualified emergency clinic if there are any concerns regarding the incision site. Printed name: Owner signature: