Canine Spay Consent Form

Sterilization of a Female Dog: This procedure involves the surgical removal of the reproductive organs (uterus and ovaries) by an abdominal incision. The animal is placed under general anesthesia and will return home the same day. The animal will receive intravenous fluids, which helps maintain blood pressure and allows for a better recovery. There will be a shaved patch on the front leg from the intravenous catheter. The abdominal region will be shaved for the procedure. She will also receive anti-inflammatory medication at surgery and to continue once home.

Follow-up: If external sutures are placed, they will need to be removed by veterinary staff in 10-14 days. If no external sutures are placed, then an incision check is recommended in 10-14 days with one of our technicians (complimentary).

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Pet's Name *

Pet's Date of Birth *

As the owner (or agent of the owner) of the animal described above I authorize and request Clayton Park Veterinary Hospital to hospitalize this animal for the purpose of a diagnosis, treatment, surgery or other procedures, as specified by this release and approve the use of the required anesthetics as prescribed by the attending veterinarian.

Your pet is being admitted for anesthesia/surgical procedure. To ensure your pet is in a low risk category prior to anesthetic we will be performing a blood profile. The blood profile is performed on site here at the hospital. This will enable us to have a base line reference prior to surgery and also act as a reference in the future should your pet become ill.

I, (the signee) understand that Clayton Park Veterinary Hospital will use reasonable caution to ensure my pets safety while it is in your care but will not hold Clayton Park Veterinary Hospital responsible if injury, escape or demise were to occur. By signing this document, I absolve Clayton Park Veterinary Hospital of liability for the procedure requested herein.

I understand that payment is due at the time that services are rendered.

Your pet will be evaluated for the following conditions upon entry. I understand that a more detailed examination under anesthetic may reveal further and additional fees may apply:

Deciduous teeth (baby teeth that have not fallen out on their own)
Umbilical hernia (a small opening in the abdominal muscles that internal organs can get stuck in)
Heat cycle (period of ovulation. Signs include: swollen vulva, bleeding from vulva, yellow/brown/red discharge from vulva, licking hind end more than normal, urinating more than normal, behaviour changes.)
Pregnancy

In the event that I am unavailable for contact and additional procedures may be deemed necessary at the discretion of the attending veterinarian:

Please select one *

I give consent for the additional procedures and I will be responsible for additional costs related to those treatments or diagnostics.
I do NOT consent to the additional procedures and I understand that this may lead to higher future costs and potentially delay treatment, which might not be in my pet's best interest.

Microchip Implantation

74% of dogs and 63% of cats who are microchipped are reunited with their owners.

A microchip is not a GPS. The microchip is a tiny electronic device the size of a grain of rice. It is encoded with a unique identification number and is implanted just under the surface of the skin, between the shoulder blades. It allows the confirmation of the identity of the pet using a scanner when the animal is found. Our microchip fee is $75 plus tax.

24Petwatch Microchip Identification: 1-866-597-2424

Please select one *

I consent to have my pet microchipped
I decline to have my pet microchipped

Pre-Anesthetic Blood Testing

Pre-anesthetic blood work helps us to assess internal organ function and red and white blood cell parameters. This helps us determine if there are any additional precautions that need to be taken before, during and after surgery. It is important to understand that pre-anesthetic blood work does not guarantee the absence of anesthetic complications. It may however, greatly reduce the risk of complications as well as identify medical conditions that could require medical treatment.

The pre-anesthetic blood work checks for:

Complete Blood Count: White blood cells (infection/inflammation), red blood cells (anemia/dehydration) and platelets (aid with blood clotting).

Biochemistry: Glucose (diabetes/hyperglycemia), ALT/ALKP/Bilirubin (liver), CREA/BUN/Phosphorus (kidney), Calcium (certain cancers, parathyroid function), Cholesterol (lipid diseases/liver), Albumin/Total Protein (proteins/hydration).

Senior patients:

T4 (thyroid): The thyroid gland is important for metabolism of all cells in the body. This is especially important to check in cats over the age of 10 years, especially if they have weight loss and dogs of any age with low energy or are overweight.

Blood work is mandatory if your pet is over 1 year of age.

Please select one *

I give consent for pre-anesthetic blood work
My pet is under 1 year old, and I decline pre-anesthetic blood work. I understand this prevents the vet from identifying underlying illnesses that could affect anesthesia or surgery plans.

Medications and Supplements

This includes medications for managing disease, human medications such as tylenol, supplements (fish oils, other joint supplements), etc.

Please provide a detailed list of the medications your pet takes. Please include the drug name, the amount your pet receives and how often your pet is given the medication.

Is your pet on any medications or supplements currently?

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Please write your pet's medications below:

When was the most recent access your pet had to food and water? *

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Today's Date *

Today

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I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *