Canine Spay Neuter Release Form

Owner

Pets Name

Date

• ANIND: Anesthesia Induction

• ANINH: Anesthesia Inhalation

• HOSSX: Hospitalization Post-Operative

• PNMGT: Pain Management

• PolySX: Antibiotic Injection

• VITMON: Monitoring of Vital Signs

• POPNMG: Post-Operative Pain Management

• IVCSX: IV Catheter

• IDPRSX: Idexx Pre-Surgical Panel Includes CBC-CHEM10

• ANIND: Anesthesia Induction

• ANINH: Anesthesia Inhalation

• HOSSX: Hospitalization Post-Operative

• PNMGT: Pain Management

• PolySX: Antibiotic Injection

• VITMON: Monitoring of Vital Signs

• POPNMG: Post-Operative Pain Management

• IVCSX: IV Catheter

• IDPRSX: Idexx Pre-Surgical Panel Includes CBC-CHEM10

The above pricing is for the UNCOMPLICATED procedures. In the event we experience a surgical complication such as your pet being in HEAT, PREGNANT, HAVING a PYOMETRA (infected uterus), being a UNILATERAL or BILATERAL CRYPTORCHID or being OBESE (BCS>or = to7/9). ADDITIONAL CHARGES MAY BE APPLIED.

Pre-Anesthetic Blood Work is the for the safety and wellbeing of your pet. Bloodwork will not be required if your pet has had bloodwork (CBC/Chem10 or greater) performed within the last 90 days and has assessed as being NORMAL. A credit of $67 will be applied.

Date last bloodwork performed

Staff Initial

Pre-Anesthetic Blood Work is the for the safety and wellbeing of your pet. Bloodwork will not be required if your pet has had bloodwork (CBC/Chem10 or greater) performed within the last 90 days and has assessed as being NORMAL. A credit of $67 will be applied.

Fecal Testing: $30.75

To ensure your pet is free of intestinal parasites that may be harmful to your pet or potentially contagious or harmful to your family. Roundworms, Hookworms and Tapeworms are potentially transmissible to humans through oral contact with soil contaminated with infected feces

Signature

Emergency Contact #

Date