Pet’s Name ___________________Breed _________________Age ___________
Owner Name ________________________________________________________
Address
_________________________________________________________
Phone
_________________________________________________________
Please read all of the following!
1. Has your pet had any food in past 12 hours? Yes
No
2. Any anesthetic procedure involves a risk, although low, of complications
including, but not limited to allergic reactions, cardiac arrest and death
3. We are a Spay/Neuter clinic, any post-surgery concerns should be discussed
with your Vet. We cannot cover charges incurred at other clinics.
4. There could be an additional charge to neuter an animal whose testicles have
not descended, or spay an animal in heat or pregnant.
5. For the protection of your pet we can offer rabies shots, vaccinations, heart
worm test and micro chipping at an additional charge.
It is important that we are left with viable phone numbers!
I hereby release the Miami Animal Alliance and Dr. Barber from any and all claims
arising out of or connected with the performance of this operation or procedure.
I am the owner of the above pet or m acting as agent* for the owner and have the
authority to execute consent.
I have read, Understand and agree to the information listed above.
Signature __________________________________Date____________________
Cost
Dogs
Spay (Female) - includes Rabies if needed
Dogs
weighing less than 40 pounds
Dogs
weighing more than 40 pounds
Neuter (Male) - includes Rabies if needed
Dogs
weighing less than 40 pounds
Dogs
weighing more than 40 pounds
Cats
Male $35 Female $45
Micro-chip
Rabies
Heart Worm Test
Vaccine
Other
$20____________
$10 ____________
$15_____________ Total _______________
$5-$10_______________
_______________ Paid ________________
$50______
$60 _____
$40______
$50 _____