INFORMED CONSENT & DISCLOSURE
FOR SPAYING OR NEUTERING

Pet Vet, Inc. &/or Project Spay/Neuter, Inc. &/or Tracy W. Land, D.V.M.
4630 Martin Road - Cumming, GA 30041
770-887-1565

· Any anesthetic and surgical procedure carries inherent risks of complications. While rare, (less than one in a thousand), serious complications including but not limited to: infection, bleeding, allergic reaction, cardiac arrest, and death – do sometimes occur. Additionally, pets sometimes damage their incisions due to licking, chewing, and/or over activity. I accept this risk, and understand that I am responsible for the costs of treating any complications.

· The risk of serious complications can be minimized, (but not eliminated), by having pre-anesthetic screening tests done to detect some, (but not all), unknown underlying medical conditions. Pre-anesthetic bloodwork can be done here for an additional $45 charge. Chest X-Rays and EKG’s can be done at nearby larger hospitals for approximately $150 to $250. Please advise the nurse if you would like to discuss or arrange for pre-anesthetic testing.

· The risk of complications can be further minimized, (but not eliminated), by certain services that we cannot provide within our fee structure. These services include, but are not limited to: complete physical examinations, placement of IV catheters, IV fluid administration, blood pressure monitoring, and/or constant EKG monitoring. Most veterinary hospitals do not provide these additional services. Those that do will typically charge a minimum of an additional $100 to $200 to cover the costs involved. If you wish to explore the availability and costs of such additional services, we understand your concerns and will be happy to cancel your appointment.

· It is assumed that patients presented for surgery are in good health. Time constraints do not allow us to perform complete physical examinations on all patients prior to surgery.

· I certify that this pet(s) has current vaccinations and does not have heartworms (dogs) or feline leukemia (cats); or if not, I accept the increased risk of complications resulting from failure to vaccinate and test. Be aware that it may take up to two weeks for vaccinations to protect your pet. Heartworm tests ($22), Leukemia test ($25) are available upon request.

· I certify that this adult pet(s) has not eaten any solid food since midnight last night, or if not, I accept the increased risk of complications that can arise from aspiration while under anesthesia.

· Pregnancy, being in heat, excessive milk, obesity, or retained testicles may complicate surgery, extend recovery, require additional after care, and additional charges may apply.

· Cats that are obese, pregnant, having a false pregnancy, or have milk engorged breasts - up to $35.00

· Dogs that are obese, in heat, pregnant, having a false pregnancy, or have milk engorged breasts - up to $45.00

· Retained testicles in dogs or cats - up to $125.00

* Charges are determined by the doctor during surgery and are based on additional time and supplies required.

· Pregnant animals will be spayed, which will terminate the pregnancy.

· I understand that I cannot allow my female pet to nurse kittens/puppies following surgery.

· I understand that I cannot allow my female pet in heat to be bred following surgery.

· If a pet has already been spayed or neutered, a charge of $25 for dogs and $20 for cats will apply to cover the cost of anesthesia, nursing care, and boarding.

· If a pet is infested with fleas and/or ticks he/she will be treated in order to prevent other pets in the clinic from becoming infested, at a charge not to exceed $16.05.

· If my pet requires antibiotics due to excessive milk or any underlying infection, I will be responsible for the charges.

· If I ask for any additional surgical procedure, physical exam, medical treatment, testing, vaccinations, medications, etc. I will be responsible for the charges.

· Dr. Land will not allow cats to leave this clinic following surgery unless he/she is in some type of a cat carrier, no exceptions.

· If Dr. Land feels that my pet requires pain medication following surgery, it will be supplied at no charge; however, if I insist on pain medication contrary to the doctor’s opinion, I will be responsible for the charges.

· If my pet rips, tears, licks, or chews open his/her incision following surgery, I will be responsible for all charges resulting from additional surgery, hospitalization, medications, etc.

· Elizabethan (lampshade) collars are available here or at any pet supply warehouse.

Payment in full is due at discharge, no exceptions.

Late charges will apply if I am not on time to pick up my pet, no exceptions.

I am the owner or agent for the owner of this pet. I am 18 or older.

I have read and understand this authorization and consent. I consent to and authorize the spaying or neutering of this pet. I hereby release Pet Vet & Project Spay/Neuter and their staff, employees, owners, directors, officers, & volunteers from any and all claims arising out of or connected with the performance of this operation or procedure.

___________________________________________
Pet(s) Name(s)

_______________________________________
Owner’s Signature

__________
Date

Check Out Monday – Friday is 3:30 pm – 6:00 pm

A late fee of $25.00 will be charged for each pet not picked up by 6:30 pm to cover staff overtime. No exceptions!

Check Out on every other Saturday is 3:00 pm – 4:00 pm

4630 Martin Road Cumming GA 30041

Phone:
770/887-1565

Fax:
770/781-4237
 

All material contained in this site (including Project Spay Neuter) are the sole property of Pet Vet and may not be used without our express permission.

Website maintained by:
Tracy Land, DVM

This page rev: 03/18/07