Mazomanie Animal Hospital, LLC

704 Emily Rd
Mazomanie, WI 53560

(608)795-4242

www.mazoanimalhospital.com

Feline Spay/Neuter Release Form

Name on Account: (required)
First Name (required)
Last Name (required)
Pet's Name: (required)

Who is available to be contacted if there are any questions or concerns on the day of surgery? This must be someone who can make decisions about your pet.(Someone MUST be available to contact between 8 am and 5 pm) (required)

What phone number can we contact this person at between 8 am and 5 pm? (Can provide multiple numbers) (required)

Did you receive and review the Care Plan / Estimate from us for your pet's procedure in the past week? (required)

Yes, and I agree to the estimate
Yes, but I have additional questions
No, please resend it


PAIN MEDICATION
A 3-5 day course of a routine anti-inflammatory/pain medication will be dispensed and is included in the cost of surgery.
If the veterinarian feels like my pet required more or a stronger pain medication(s), there will be an additional charge for this.
(required)
I understand I will be responsible for the fees associated with these, even if they are not included on the Care Plan/Estimate
IV FLUIDS
Intravenous Fluids help maintain blood pressure, hydration, and good organ function while an animal is anesthetized. This is typically required for most anesthetic procedures and is likely included on your estimate.
(required)
I understand I will be responsible for the fees associated with this, as shown on the estimate
PRE-ANESTHETIC BLOODWORK
If your pet is young, healthy and having a routine surgery, Bloodwork may be optional for your pet. It is highly recommended to make your pet’s anesthetic procedure as safe as possible.
We wish we could include this in the basic package for every pet, but we realize that many people have financial concerns and we feel an obligation to keep our surgery prices affordable for everyone. We offer the best level of care possible while giving you, the pet owner, control to make the decision for your individual circumstances.
Many conditions, including disorders of the liver, kidneys, or blood, are not evident physically but could possibly lead to complications.
The tests will help to check many things including the function of the liver and kidneys, which are vital to eliminate medications used for anesthesia.
These are the same tests your doctor would perform on you before any routine surgery. Our laboratory equipment allows us to run these tests within minutes.
If the results are abnormal, we will call you to discuss options and if normal, they will give us and you peace of mind to proceed with anesthesia today.
If Pre-Anesthetic Bloodwork is optional for your pet and has not been performed yet:

Yes, I would like it performed prior to surgery and I understand there is an additional cost for this as shown on the Care Plan.
No, I decline bloodwork and I understand there could be complications due to underlying disease not being caught prior to surgery.


VACCINATIONS
RABIES AND FVRCP: All pets are required to be current on Rabies Vaccine as well as Feline Virus' Vaccine to be in our hospital for the day.
I understand that if my pet is not current, they will be updated on these vaccinations, at my expense.
OTHER OPTIONS (There is an additional fee for each of these items that may not have been on your original estimate):
Feline Leukemia (FeLV) / FIV Testing:
These are feline viruses that can be transmitted through close social contact, such as in utero during pregnancy, through saliva by cat bite or sharing water and food dishes. For more information, please visit:
FeLV: https://veterinarypartner.vin.com/default.aspx?pid=19239&id=4951934
FIV: https://veterinarypartner.vin.com/default.aspx?pid=19239&id=4951815

Yes, I would like FeLV / FIV testing on my cat today
No
I would like to discuss further


FeLV VACCINATION - This is recommended for cats that go outside and / or have exposure to other unknown cats, not in their household. If they have not received this vaccine in the past, they will need a booster in 3-4 weeks after the initial vaccine.

Yes, Please start the vaccine series on my cat today
No
I would like to discuss further


MICROCHIP - Microchipping is a simple, safe way to know that if your dog ever strays off and is brought to any humane society or veterinary clinic in the United States, they should be easily and quickly identified and reunited with you.

Yes, please administer at the time of surgery
No
I would like to discuss further


Selection :

Verify the reCAPTCHA: