Animal Hospital Consent Form | Gwaii Animal Helpline Society

Animal Hospital Spay & Neuter Consent Form

First and Last Name

Phone Number

Full Address (Include Village/City & Postal Code)

Pet’s Name

Pet’s Birthdate or Age

Dog or Cat?

dog

cat

Male or Female?

male

female

Brief physical description of pet (eg. breed, colour, type of fur):

Is your pet currently on any medications?

yes

If yes, what kind of medication?

When was it last given?

Please read and accept the following:

I, the undersigned, hereby confirm that I am the legal owner of the above-noted animal, or I have full authority from and on behalf of the legal owner of the above-noted animal and as such I hereby authorize the Queen Charlotte Animal Hospital Ltd and/or its employees (“the clinic”) to perform: if male a neuter (orchiectomy) if female a spay (ovariohysterectomy/ovariectomy) and if my pet is found to be pregnant, I authorize the DVM (the vet) to proceed with the surgery and terminate the pregnancy. I understand there is a small risk of anesthetic complication including death and accept the nature and risk of this procedure that the clinic deems necessary and desirable. I hereby grant consent and authority to the clinic to remedy conditions that are not known at the time that the procedure is commenced. I hereby release the clinic and its employees from any and all liability and/or claims arising from the diagnosis and/or performance of the above-noted procedure, together with any procedural functions performed on the animal, and any related services or procedures deemed necessary by the clinic. I understand that some drugs administered to my pet may not be licensed for use in dogs and/or cats. I understand that 24 hour continuous monitoring is not routinely available for hospitalized patients. Any animal not called for within five days will be considered abandoned and disposed of as seen fit by the clinic. PLEASE NOTE: If retained deciduous teeth are found during my pet’s pre-surgical exam I consent to have these teeth removed to avoid any complications with the growth of my pet’s adult teeth.

Although not required, pre-anesthetic blood work is available for pets under 7 years old, for $70.00. Payment must be made at the time your pet comes in to be spayed or neutered.

If your pet is over 7 years old, Gwaii Animal Helpline Society covers the cost for the pre-anesthetic blood work.

If your pet is under 7 years old, pre-anesthetic blood work is $70 plus gst (over 7 years old no charge for pre-anesthetic blood work)

Yes, my pet is under 7 years old and I accept the fees.

For your information: Performing this blood work before the operation reduces the risk but may not prevent complications. It does help the medical team to: minimize the risk of anesthesia by determining the safest medications to use for your pet, identify any underlying diseases not found by the history or physical examination, establish healthy baseline values, make the decision that procedures be postponed and to perform additional diagnostic testing or treatments if indicated.