PET’S NAME:________________________________
DATE:_______________
CONSENT FOR SURGERY, ANESTHESIA, AND REQUESTED SERVICES:
Please read the following statement before signing. By signing below, you authorize North Florida
Animal Rescue’s staff to perform surgery and / or the requested procedures. It is important for you to
understand that the risk of injury or death, although extremely low, is always present just as it is for
humans who undergo surgical and medical procedures.
1. Acting as owner or agent of the identified pet, I request and authorize North Florida Animal Rescue and the
veterinarian to perform surgical sterilization by castration (males) or ovariohysterectomy (females). I also authorize the
selected vaccinations, tests, and procedures identified below.
2. I understand that surgery and the use of anesthetics and drugs create an element of risk for injury or death. I am
responsible for notifying North Florida Animal Rescue, prior to surgery, of any pre-existing conditions. These conditions
include illnesses, seizures, allergies, or any other relevant information. I understand that some factors significantly
increase surgical risk and bleeding tendencies, including pregnancy, estrus (“heat”), obesity, uterine infection, previous
abdominal surgery including C-sections, and diseases such as heartworms, internal parasites, feline leukemia, and feline
immunodeficiency virus. I understand that my animal has not been tested for clotting abnormalities and that some
animals have genetic clotting problems that cannot be detected on a routine physical examination prior to surgery.
3. I understand that vaccinations can cause adverse reactions in some animals. These adverse reactions can include but
are not limited to: depression, swelling at the injection site, fever, vomiting, diarrhea, swelling of the face, paws, and head,
and rarely death. I understand that I am responsible for notifying North Florida Animal Rescue if my animal has had
previous vaccine reactions. I understand that it takes up to three weeks for vaccinations to protect my animal and that
some vaccines require boosters before an animal is protected.
4. I understand that in cats, some vaccinations and injections have been linked to the formation of injection-site related
cancer, including but not limited to fibrosarcoma. I understand that any medical procedures or treatments that may result
from injection site complications are the financial responsibility of me, the client, and not North Florida Animal Rescue, the
vaccine company, or the veterinarian.
5. I understand that as long as the attending veterinarian determines the animal is an acceptable surgical candidate,
sterilization procedures will be performed regardless of the animal’s gender, including pregnancy determined during
surgery. I also understand that the attending veterinarian may refuse to perform any procedure for any reason. If I cannot
be reached at the phone numbers I have given and the veterinarian determines that there are problems that should be
discussed prior to anesthesia, the surgery will not be performed and the animal will be sent home and rescheduled.
6. I certify that all food and water was taken away from this animal on or before 8:00 pm on the night prior to surgery. I
understand that if I did not take the food up, there is a much higher risk to the animal during and after surgery including
vomiting under anesthesia and aspiration pneumonia. I also understand that if my animal vomits food at the veterinary
clinic after arrival, surgery may be cancelled for that day and rescheduled. I also understand that diarrhea, vomiting,
fever, or other illness observed after arrival may result in the cancelling of my pet’s surgery.
7. I understand that animals receiving outpatient surgery are not to be kept overnight at this facility unless prior
arrangements have been made. If my animal is not picked up by 5:30 pm, I may incur a boarding fee up to $50.00 per
day for a large dog.
WE RECOMMEND ALL MALE DOGS LEAVE THE CLINIC WITH A RECOVERY OR “E” COLLAR TO PREVENT
LICKING AND CHEWING OF THE SURGERY SITE. MOST PUPPIES WILL NOT HAVE A COLLAR.
ALL SPAY INCISIONS IN FEMALES ARE MARKED WITH GREEN TATTO INK AS A PERMANENT SIGN OF SPAY
SURGERY. Please do not try to clean off this green material, it is there for a reason.
Requested Vaccines and Services
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SIGNATURE:_________________________________________________DATE:______________________