FELINE SPAY $50 FELINE NEUTER $35 CANINE NEUTER $60-65 CANINE SPAY $70-75
****Canine extra weight charge: $1.00 additional fee per pound over 60lbs****
Date____________
Age: _______
Oregon Spay/Neuter Fund Program
Consent Form
Owner’s Name____________________________________
WT: _______
Temp: _______
Client ID: ________________
Phone #___________________ *If we call you & do not hear back today, your pet may not be
spayed/neutered*
Pet’s Name: ________________________
Species: K9
FELINE
Sex: M
F
Oregon law mandates the use of pain medication for ALL pets having surgery. All pets will receive the BRONZE pain
relief package for this surgery. Our induction anesthesia contains an opiate that will assist in pain relief for the first 24 hours
after your pet’s surgery. All pets will also receive a NSAID given in hospital. This medication will last five days for cats and
24 hours for dogs. The fee for this required pain relief package is $10.00 (additional pain relief packages
recommended and listed below).
ALL PETS with live fleas will be treated at owner’s expense. Additional charges will apply for animals
who are in heat or pregnant. Feline $26.00-46.00 Canine $36.00-56.00
*ALL DOGS AND CATS (4 months or older) – Must be current on Rabies vaccine or receive in hospital
today. **Owner provided proof _________ or Rabies is needed ____________1yr/3yr
COMP SURGERY EXAM
COMP SURGERY EVAL
HEALTHCARE MAINT. EXAM
I understand the above mandatory requirements ______________ (Initials)
*All Pets who are AGGRESSIVE will be charged an aggressive handling fee of $40_____
(initials)
*All pets MUST be fasted the night before. If pet vomits, they will be given an injection for
their safety. This injection is $50-90(depending on weight) _________ (initials)
Optional services available and recommended
ACCEPT
DECLINE
PRE-ANESTHETIC BLOOD PROFILE (OPTIMAL) - $146.15
Comprehensive blood screen that tests liver and kidney function,
CBC, electrolytes and glucose prior to administering anesthesia
Fractious pets may need to be sedated in order to get sample.
_________
_________
_________
_________
_________
_________
K9 – Additional NSAID to go-home (5 day supply)$31-$56 (dep. on weight). _________
Feline – Additional opiate given in hospital (lasts 12 hours) $24.92
_________
OR BLOOD SCREEN- $61.32
Blood screen that tests liver and kidney function, glucose and PCV
Fractious pets may need to be sedated in order to get sample.
GOLD PAIN RELIEF PACKAGE (OPTIMAL) –
K9 - Additional sustained release opiate given in-hospital (lasts 3 days)
& NSAID to go-home (5 day supply). $57 - $82 3
Feline – Additional sustained release opiate given in-hospital (lasts 3 days).
$52.84
SILVER PAIN RELIEF PACKAGE
IV CATHETER AND FLUIDS (OPTIMAL) - $61.70
Anesthesia/sedation lowers blood pressure and decreases
blood flow to vital organs. This option decreases risk during surgery.
Fluid administered IV.
_________
_________
SUBCUTANEOUS FLUIDS – $32.86
Anesthesia/sedation lowers blood pressure and decreases
blood flow to vital organs. This option decreases risk during surgery.
Fluid administered under skin.
_________
_________
MICROCHIP – $37.16
This chip then holds your pet’s identity for
life. If your pet is ever lost or stolen veterinary practices and shelters
scan for a microchip before adoption or euthanasia.
____________
___________
EXTRACT IMPACTED DECIDUOUS TEETH - $26.11ea
________
______
DEWCLAW REMOVAL - $40.03ea or $79.07ea
________
______
UMBILICAL HERNIA REPAIR- $75.83
________
______
RETAINED TESTICLE - $41.02 or $71.13
_________
________
RECOMMENDED ROUTINE CARE
By de-worming your pet you are protecting your family.
10,000 children alone are affected annually by roundworms transmitted by dogs and cats, 1,000 of who
lose their vision as a result.
CANINE DEWORM/PPM2 –
Oral liquid that treats for roundworms,
Hookworms, whipworms and tapeworms
$31.43(2 doses)
_________
_________
FELINE DEWORM/PP2 Oral liquid that treats for roundworms,
Hookworms and tapeworms
$24.01 (2 doses)
_________
_________
FELINE DEWORM/PROFENDER Topical solution that treats for roundworms, hookworms and
Tapeworms
$13.38-$21.64
_________
_________
VACCINES-
Cats
Dogs
Fvrc2p/Felv
______3wk/1yr
Rabies
______1yr/3yr
FIV (test req.) ______2wk/1yr
FIP
______3wk/1yr
ADDITIONAL SERVICESFIV/FeLV Test
Heartworm, Lyme, E. Canis Test
Dental Club Dental
DHLPP/Corona
*Rabies
Bordetella
Lyme
Influenza
______3wk/1yr
______1yr/3yr
______3wk/6mo
______3wk/1yr
______3wk/1yr
__________
__________
__________
Feral Cats – Ear tipped at no additional charge
_____ YES _____ NO
Medication given within 30 days: _____________________________________________
If yes please specify: (last dose given, dose, etc.) ___________________________
____________________________________________________________________
Medical conditions/concerns: _________________________________________________
I understand that there are some risks under any anesthetic, but will hold Newport Veterinary
Hospital in no way responsible under any circumstance. I thoroughly understand the
information on this sheet is correct and by signing below, I understand and accept the policies
of the hospital.
AUTHORIZATION______________________________________________________
Patient:__________________________
WT:_______________
Client # :___________________
Species:_______________
Breed:__________
Procedure:________________________________ Dr. Performed SX:_________
Anesthetic-Dose/Route:
TTDEX:
Doctors notes:
Propoflo:
Pain Relief- Dose/Route:
Carprofen:
Rimadyl:
Other:
Metacam:
Other:
Wt:
Temp:
HR:
RR:
MM:
CRT:
Other:
Aditional Pain Relief-Injectable-Dose/Route:
Buprenex:
Torb:
Other:
Antibiotic-Dose/Route:
Anbipen:
Convenia:
Vaccines:
Caninie:
Rabies (1yr/3yr)
DHLPPC (3wk/1yr)
Influenza (3wk/1yr)
Bordetella (3wk/6m)
Lyme (3wk/1 yr)
Feline:
Rabies (1yr/3y)
FVRC2P/FELV (3wk/1yr)
FIV (2 wk/1yr)
FIP (3wk/1yr)
Bloodwork/Tests:
OR Blood
General
Heartworm:_____________
Additional Tx:
Go Home Meds:
Diagnostic
Prescreen
Fecal:__________
T4