Spay/Neuter Owned Animal Application

The Animal Shelter of Sullivan County Spay/Neuter Application for Owned Animals

Owned Animal Spay/Neuter Application

Owner's First Name *
Owner's Last Name *
Please upload a photo of your Drivers' License or Government ID *
Owner's Street Address *
City *
State *
Zip Code *
Owner's Phone Number *
Owner's Email
Pet's Name *
Please upload a picture of your pet needing spayed/neutered. *
Breed of Animal *
Age of Animal
Please estimate weight of the animal.
Male\|Female
If female, has she had babies? *
If female, is she currently in heat? *
Has your pet shown any signs of illness within the past 7 days? (Example: coughing, sneezing, lethargy, vomiting, diarrhea etc.) *
Please explain if your animal has shown any signs of illness in past 7 days.
Does your pet have any allergies? *
Please list allergies.
Does your pet have any underlying or chronic illnesses or conditions? *
Please list any Chronic Illnesses or conditions your animal has.
Has your pet ever had a vaccine reaction? *
If yes, what type of Vaccine Reaction?
Do you have any other concerns at this time?
If you have any concerns, please list here
Does your animal have a current rabies vaccine or other current vaccines? If yes, please bring proof to your appointment *
Is your animal microchipped? *
Please choose any of the following services you would like performed at the time of surgery:
For our mature patients, at the discretion of the veterinarian, bloodwork will be completed prior to anesthesia or surgery. This testing will check liver and kidney function along with protein levels, blood sugar, and red/white blood cells counts. Occasionally we may have to postpone surgery until a medical condition is resolved. The cost is $52. Note:If the labwork is declined and the veterinarian feels it is in the best interest in the care of the animal, the veterinarian may cancel the spay/neuter. *
I, the undersigned owner, or agent of the pet, authorize the staff of The Animal Shelter of Sullivan County, to spay/neuter my pet. I have read and agree: *
I understand that some risks always exist with anesthesia and/or surgery. I am encouraged to discuss any concerns I have about those risks with the attending veterinarian, veterinary technician, or veterinary assistant before the procedure is initiated. I have read and agree. *
While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved. I also assume full responsibility for any additional expenses incurred after the surgical procedure is performed, such as emergency referral, re-check physical exams, and additional surgery due to post-op complications. These are more likely to occur when there is a failure to comply with the aftercare instructions. I have read and agree. *
I am over 18 years of age and understand the veterinary staff will make every effort to contact me regarding treatment in case of any unforeseen emergencies. If unable to reach me, the staff has permission to proceed with life-sustaining procedures. I have read and agree. *
If my animal is found to have fleas/ticks or parasites, I understand that my animal will be treated to protect my animal as well as the other animals. I understand this will be at my expense. *
Your regular veterinarian must address illnesses or injuries that are not a direct result of surgery. We cannot be held responsible for complications resulting from failure to follow post-op instructions or for contagious diseases for which the animal was not previously properly vaccinated. If serious complications arise after normal business hours, I will contact the Airport Pet Emergency Vet at 423-279-0574. I have been provided an estimated cost for the procedure(s) listed above. I assume financial responsibility for the recommended services and will provide payment in full at the time my pet is discharged from the hospital. I have read and fully understand the terms and conditions set forth above. I have read and agree *
Date
Signature *
Contact Phone Number/Alternate Phone Number *

Together we can do great things for the animals of Sullivan County