Row concave Shape Decorative svg added to bottom [ Client Resources ] Spay & Neuter Consent Form Spay Neuter Consent Form Owner's Name * Owner's Name First Name First Name Last Name Last Name Patient's Name * Date * Email * Phone * May we text you? * Yes No Congratulations: You came to Cat Care Clinic because you want the best for your cat! Our standard of care is the highest you will find at any veterinary hospital. Our Spay/Neuter package includes all standard services, which may be considered “optional” elsewhere. We do not sacrifice important safety procedures. If the doctor feels that additional procedures are necessary, you will be consulted in advance. Important Notes: FeLV/FIV and Fecal test results on file required. Cats must be up to date on Rabies and FVRCP vaccines. Additional $75 for pregnant or in-heat cats. Female Male Pre-anesthetic exam $75.00 $75.00 Pre-anesthetic blood work $59.25 $59.25 Blood Collection $22.25 $22.25 * Anesthesia / Sedation $133.50 $90.00 IV Catheter + Fluids $88.75 n/a Monitoring Equipment $16.25 $16.25 Surgery $105.00 $73.50 O.R. Sterilization/Disposables $35.75 $35.75 Onesie $16.00 n/a Post-op Pain injection $38.00 $38.00 * Go-Home Pain Meds $20.00 n/a * Local Nerve Block $30.25 $30.25 Bio-Hazard disposal $7.75 $7.75 Subtotal $647.75 $448.00 Package discount -$200.00 -$129.30 Total $447.75 $318.70 **Anesthetic Gas: Sevoflurane is a state-of-the art anesthetic gas that is used in 95% of human hospitals, including on neo-natal infants. Sevoflurane allows the doctor to maintain a better anesthetic plane so less gas is needed. Other Services Available Rabies ($37.00) FeLV ($36.50) FVRCP ($24.00) Fecal ($43.00) FeLV/FIV ($63.00) Microchip ($60.00) Flea/TX ($24.00-$30.00) Resuscitation Orders Agreement Resuscitation Orders in the Event of an Emergency: For every cat in our care, we need to know, in advance, what your wishes are in the unforeseen event of an emergency if he or she stops breathing and/or their heart stops beating. CPR has the best chance of being successful if started immediately. We will make every attempt to contact you right away should your cat require resuscitative efforts. Please review and select one option below. Cardiopulmonary Resuscitation (CPR): All resuscitative efforts including placing a breathing tube, providing chest compressions and IV medications are to be attempted to restore normal heart function and breathing as deemed necessary by the doctor until I can be reached. Should my cat require cardiopulmonary resuscitation (CPR), I request that the doctor(s) pursue such medical care indicated above. I understand that this is a cost in ADDITION to any estimate and agree to pay this fee. The cost of full CPR is typically an additional $300 - $500 or more. Patients who are successfully resuscitated are often critical and will require transfer to a 24-hour facility for at least 24 to 48 hours of intensive care and monitoring following resuscitation. Do Not Attempt Resuscitation (DNR): Aside from reversing any reversible sedatives or anesthetic drugs that have been administered, no cardiopulmonary resuscitation (CPR) efforts are to be attempted allowing natural death. Be assured that we do everything possible to prevent this from happening and electing DNR does not affect selected treatments. Please select one of the following * Cardiopulmonary Resuscitation (CPR) Do Not attempt Resuscitation (DNR) Additional information and consent: I understand that there are risks associated with anesthesia and surgery, up to and including death. Results cannot be guaranteed. I am responsible for all fees incurred regardless of the outcome of the procedure. There will be additional fees for other conditions such as pregnancy, in-heat or cryptorchidism. Any fleas or other parasites will be treated at your expense. I am the owner or agent for the owner of the above-named cat, and I have the authority to execute this consent. I hereby consent and authorize the above procedures. Signature * signature keyboard Clear Date * Submit If you are human, leave this field blank.
