BBAWC Surgery Clinic Pet Owner Intake

NOTE: COMPLETING THIS FROM DOES NOT BOOK YOUR APPOINTMENT.

You should receive a separate email confirming your appointment. If you have not received that email, your appointment may not have been booked. You can book appointments at this link.

Thank you so much for scheduling an appointment with our rescue clinic!

This form should be completed the night before the surgery. We cannot accept cats for surgery until this form is completed and received into our system.

Appointment Information

Name Appointment is under *

Appointment Date *

The appointment date comes from the appointment you booked at this link.. If you have not paid a fee and have a booking number you do not have an appointment and should not fill out this form as it will be ignored.

Owner Information

Pet Owner First Name *

Pet Owner Last Name *

Owner Email *

Owner Phone Number *

Owner Street Address *

Owner City *

State *

Zip code *

How did you hear about our clinic? *

Cat Information

Has the cat been to this clinic before? *

Animal Name *

Is the cat feral? (Unfriendly and not handleable) *

Species *

Breed (Please select) *

Coat Color/Markings *

Age. If unsure estimate or put unknown *

Sex? (Please select) *

Please provide as much background as possible so we can provide the best care for the cat.

Has the cat ever been to the Vet? When? What for? *

Has she had a litter? *

Is the cat eating and drinking normally. *

Any recent noticeable change in weight? *

When will food be taken away from the cat before surgery? We recommend 11pm the night before for Adult cats and 5am the morning of the procedure for kittens 4lbs and under. *

Does the cat have any current medical conditions (including coughing, sneezing, vomitting or diarrhea) that you are aware of? *

If yes, please describe *

Has this cat had any flea treatment or vaccines? When did they have them? Please provide dates if possible. *

What flea or vaccine treatments has the cat received? *

Is the cat taking any medications? *

Please describe any medications the cat has been given in the last 30 days. *

Where did the you get the cat? *

What Borough Does the Cat Live in? *

Is the cat an indoor only, outdoor only, or indoor/outdoor cat? *

If the cat spends time outdoors, on average, approximately how many hours per day is it outside?

If the cat is allowed outdoors, during what time of day is it generally outside? *

Are there other pets in the household? If yes, please list the number and species (e.g., 2 cats, 1 dog, 3 birds) *

Any additional information we should know about this cat?

Each cat will have a pre-surgical exam (post sedation for feral cats or those who can’t be handled), be given an FVRCP and Rabies, flea treatment and a microchip all included in the reservation price. Extra charges apply for spay (+$20), pregnant spay (+$35), cryptorchid neuter (+$20). At the discretion of the veterinarian some purebred cats and cats over 4 years old will receive a Cardio proBNP blood test ($25). This test is a screening tool looking for indicators of underlying heart disease. This test is available upon request as well.

Post anesthesia the veterinarian may find that the cat requires additional treatment for medical conditions discovered during a sedated exam including Convenia (injectable antibiotic), Drontal (for tapeworms), infected ears and ear mite treatment. These conditions will be treated and additional charges will apply. Signing the form below indicates your understanding and agreement to these treatments.

Please select the services you need that are included in the cost of surgery (pick all that apply). *

If you did not select Rabies, FVRCP and microchip be given above, you will need to email proof of current vaccination and microchip to clinic@bbawc.org at least 24 hours before your appointment.

What additional medical services do you need (pick all that apply)? *

Please note that any questions or concerns regarding post surgical issues should be emailed to clinic@bbawc.org. The clinic is not open every day but the email will be monitored. If the cat is in distress and you feel there is an emergency please take the cat to an emergency hospital and do not wait for a response.

I being of legal age (18 or older) and lawfully authorized to make decisions on behalf of the animal described above (the "Cat") hereby agree to the following:

Consent for Surgery, RIsks associated with Surgery and Anesthesia

I heareby authorize and give my consent to BBAWC to receive, prescribe for, treat and/or perform sterilization surgery and/or administer vaccinations and/or microchips as indicated above. I understand that the cat may have medical issues that are unknown to BBAWC and therefore the Cat may be at greater risk for surgery. I understand that the likelihood of such unknown or undisclosed medical issues is higher in an animal that is considered to be feral. I recognize that feral cats cannot be handled by the medical staff while awake and can only be examined after anesthesia. I understand that so long as, in the opinion of the attending veterinarian, it is determined that the animal is an acceptable surgical and/or vaccination candidate, sterilization procedures and/or vaccinations will be performed regardless of the Cat's sex or or medical condition (including pregnancy). I understand that the Cat could die during or after anesthesia or surgery, and that these risks are more likely to occur if I did not follow pre-surgery feeding instructions. 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 Cat. I understand that the Cat will receive a small tattoo on his or her underside to show that he or she has been sterilized.

I understand that every effort will be made to achieve a successful outcome and to provide for the safety of both humans and animals at the clinic. I understand and agree that BBAWC shall not be liable to or held responsible by me in any manner for, or in connection with, the procedure to be performed on the Cat, and I hereby hold BBAWC harmless from and against any and all liability and damages that may arise. I understand the Cat shall be administered with a local and/or general anesthesia for surgery. If, in the course of treatment or during the procedure, a condition is discovered which requires medical attention or additional procedure(s), I consent that the attending veterinarian may, in his or her absolute and sole discretion, perform such a procedure without seeking additional authorization or consent from me. I consent to these procedures and agree to pay for them. I understand that the medical staff can refuse to perform a procedure on any animal for any reason. Such refusal is the sole discretion of the BBAWC attending veterinarian.

Post Operative Care and Complications

I will take full responsibility, financial and otherwise, if the Cat becomes ill after surgery. I understand that BBAWC Surgery clinic has limited medical staff and that if there are complications I must email clinic@bbawc.org with concerns. I understand that if there is a life threatening issue before BBAWC can respond I am responsible, financially and otherwise, for taking the Cat to a twenty four hour emergency clinic.

Hold Harmless

I understand that every effort will be made to achieve a successful outcome and to provide for the safety of both humans and animals at the clinic. To the fullest extent permitted by applicable law, you shall indemnify, defend, save and hold harmless BBAWC, its officers, directors, employees, agents, successors and assigns from and against any and all losses of any nature that arise out the services provided at this clinic.

I hereby warrent that (A) I am over 18 years of age, (B) have read this agreement carefully prior to its execution, (C) fully understand this agreement, (D) realize this agreement is an enforceable legal document between myself and BBAWC and (E) voluntarily sign this agreement of my own free will.

Please Type first and Last Name *

Email of person filling out form *

Signature and Agreement (sign with finger or cursor) *