Spay/Neuter Application

Please complete one application per pet.

Owner Information
First Name *
Last Name *
Street Address *
City *
State *
Zip Code *
Phone Number *
Can we text this phone number?
Email Address *
Animal Information
Pet's Name * If you have more than one pet, a form must be completed for each pet.
Species *
Gender *
Age *
Color *
Weight (Estimate) *
Please attach a picture of any current or past vaccination records, if applicable.
Does this pet have a current rabies vaccination? * Please bring all current vaccination records to your appointment. If proof of a current rabies vaccination isn't presented, you will be required to purchase one for $10.00
Please select any additional services.
Would you like your cat to receive a FVRCP vaccine for free? * The FVRCP vaccine is a core vaccine that helps prevents common respiratory viruses.
Please select any additional services.
Would you like your dog to receive a DAPP vaccine for free? *
Does your pet have any medical conditions that you are aware of? *
If yes, please explain.
Has your pet ever shown aggression towards people in a veterinary setting? *
If yes, please explain.
Are you part of a low income household or receive government assistance?
Is there anything else that would be helpful to know about your pet?
Surgical And Anesthesia Risk Acknowledgment
I understand that my pet is scheduled to undergo spay/neuter surgery, which requires general anesthesia. I acknowledge that anesthesia and surgery always involve inherent risks, even when appropriate and accepted standards of care are followed. I understand that possible complications may include, but are not limited to: adverse drug reactions, abnormal heart rhythm, respiratory complications, bleeding, infection, delayed healing, organ dysfunction, permanent injury, or death. Some risks may not be predictable or preventable. I understand that: • A veterinarian has examined my pet to the extent reasonably available in a shelter/surgical setting and has determined my pet is a candidate for surgery. • Additional diagnostics (such as bloodwork or imaging) may reduce, but cannot eliminate, surgical or anesthetic risk. • No guarantee or warranty, express or implied, has been made regarding the outcome of surgery or anesthesia. * Initial
Authorization for Medical Treatment
I understand that medical decisions during anesthesia or surgery may need to be made quickly in the best medical interest of my pet. I authorize the veterinary team to provide reasonable and customary medical treatment as deemed medically necessary. I accept full financial responsibility for any additional medical care or emergency treatment that may arise as a result of surgery or anesthesia. * Initial
Post-Surgical Care and Owner Responsibility
I understand that my pet may be groggy when released and must be kept in a safe, enclosed area for at least 24 hours following surgery. I agree to monitor my pet for post-surgical complications, including but not limited to incision issues, lethargy, lack of appetite, or signs of infection. I understand that if post-surgical complications occur, I am responsible for arranging follow-up veterinary care at a full-service veterinary clinic at my own expense. * Initial
Flea Treatment Disclosure
I understand that if my pet shows evidence of fleas at the time of surgery, Capstar will be administered and I will be charged an additional $10.00. * Initial
Animal Pickup Requirement
I agree to retrieve my pet between 3:00 p.m. and 4:00 p.m. on the day of surgery. I understand that animals not picked up as scheduled may be considered abandoned and subject to citation under applicable law. * Initial
Release of Liability and Indemnification
To the fullest extent permitted by law, I voluntarily assume all risks associated with anesthesia, surgery, handling, housing, and care of my pet. I agree to release, discharge, hold harmless, and indemnify Maury County Government and Maury County Animal Services, including their agents, officers, veterinarians, contractors, volunteers, and employees, from any and all claims, losses, injuries, damages, liabilities, or costs arising directly or indirectly from the spay/neuter surgery or related care, including escape, illness, injury, complications, or death, provided reasonable and customary care is rendered. * Initial
Anesthetic Emergency Instructions
In the event of Anesthetic Emergency, Please select one option. *
Completing this form does not guarantee service. An employee will contact you with additional information and instructions.
I confirm that I am the legal owner or authorized agent for the above pet; I am over 18 years of age; I have read and fully understand this consent; I have had the opportunity to ask questions; and I consent to anesthesia and surgery under the terms stated above. *

Spay/Neuter Application

Owner Information

Animal Information

Surgical And Anesthesia Risk Acknowledgment

Authorization for Medical Treatment

Post-Surgical Care and Owner Responsibility

Flea Treatment Disclosure

Animal Pickup Requirement

Release of Liability and Indemnification

Anesthetic Emergency Instructions

Completing this form does not guarantee service. An employee will contact you with additional information and instructions.