Neuter Release Castration Release Form "*" indicates required fields Name* First Last Pet Name* Pet Name SpeciesDogCatPhone*Date of Procedure* MM slash DD slash YYYY Owner's Date of Birth* MM slash DD slash YYYY This is required by the DEA for us to dispense certain pain medications.Terms and Conditions* I have read and understood the Terms and ConditionsI, the undersigned, do hereby certify that I am the owner (duly authorized agent for the owner) of the animal named above. I do hereby grant permission to Dr. Evelyn Tom, Singing Hills Animal Hospital, Inc., their agents, servants, and/or representatives full and complete authority to perform the surgery or diagnostic procedure known as castration. I authorize additional procedures that, at their discretion, may be advisable and useful to promote/protect the health of the above described pet. I do hereby forever release Dr. Evelyn Tom, Singing Hills Animal Hospital Inc., their agents, servants, and/or representatives from any and all liability arising from said surgery or procedure on said animal. I understand that if my pet has only one or no testicles descended there will be an additional charge of $250-$350 for cats and $250-$389 for dogs* I understand For the safety of your pet, an intravenous catheter and fluids are required during surgery. This increases safety by keeping blood pressure higher, increase perfusion of vital organs, increase speed of clearance of anesthesia, and aid in life saving protocols.* I understand I understand pain medications will be administered after surgery* I understand I understand an e-collar is mandatory to keep pets from licking or chewing surgical sites during recovery. One courtesy e-collar will be provided. If lost or damaged, a replacement will be provided for an additional fee.* I understand I certify my pet has not eaten within the last 12 hours* I understand I understand my pet is fasted for surgery, however, if an anti-nausea medication is needed, there will be an additional fee* I understand I understand my pet must be current on vaccinations required by Singing Hills Animal Hospital policy. If determined by record or examination that my pet is due for vaccinations, I authorize vaccinations to be performed at my expense.* I understand If fleas are found on your pet, we will administer a treatment to them to prevent the spread of parasites to other pets in the hospital. I understand that I will be responsible for fees incurred.* I understand Singing Hills Animal Hospital is not responsible for any items I may leave, such as collars, leashes, toys, and blankets.* I understand Additional ServicesIn order to better evaluate the ability of your pet to undergo anesthesia the doctors recommend a pre-anesthetic blood test for existing infection, kidney, liver, and overall organ functions. The fee for this is an additional $127-$199 and is mandatory for pets 7 years of age and older.*AcceptDeclinePlease choose if you would like your pet to receive a pre-anesthetic blood test.Does your pet have a microchip?* Yes No Would you like your pet to receive a microchip today? (Additional fees will apply.)* Yes No By checking this box and signing below, I certify that I am the rightful owner of the above named pet and agree to the above statements.* I agree Owner's Signature*
