Spay/Neuter Authorization Form
St. Tammany Humane Society Veterinary Clinic
Pets Name ________________________Owner’s Name ____________________________ Date: ___________
***It is VERY important that you take time to review this sheet and sign the authorization. ***
We have your pet scheduled for surgical sterilization (Spay or Neuter).
The estimated cost of your pet’s procedure today is
based upon weight.
Spay
Neuter
Canine 0-25#
$85
$85
Canine 25.1-50#
$95
$95
Canine 50.1 – 75#
$120
$105
Canine 75.1-100#
$150
$115
Feline
$70
$58
PLEASE NOTE THAT ADDITIONAL CHARGES MAY APPLY IF:
* We are unable to confirm your pet is current on vaccinations………………..varies
* Pet is found to have live fleas ……………………………………………….…$ 5.75
* Female dog being spayed is in heat…………………………………….…..…$40.00
* Female dog being spayed is pregnant, obese, or has uterine damage ……$70.00
* Female cat being spayed is in heat …………………………………….…..….$25.00
* Female cat being spay is pregnant, obese, or has uterine damage ……….$50.00
* Male dog being neutered is cryptorchid (testicles not descended)…..up to $89.00
* Male cat being neutered is cryptorchid (testicle not descended)…...up to $50.00
* It is our policy to send all surgical patients home with three days of post-operative pain medication which is an additional $13.75.
**It is not always possible to determine if a female is pregnant prior to visual examination of the uterus during surgery. In order to adhere to you
wishes in case of an unexpected pregnancy, please choose one of the following:
_____I wish to have my pet spayed, even in the case of pregnancy
_____If my pet is pregnant, I choose NOT to have her spayed at this time, understanding that charges for the anesthesia and pain control will be
applied and may be higher that the initial quoted spay charge. I am also aware that the exposure to anesthesia could adversely affect the
development of the fetuses.
Pre-Surgical Bloodwork: Like you, our greatest concern is the well being of your pet. Prior to putting your pet under anesthesia, we recommend
pre-surgical blood work to evaluate your pets overall health (screens for hypoglycemia, kidney disease, liver disease and anemia.) If you have not
had these test peformed in the last 14 days, the additional cost for these tests is $42.95 and will be completed prior to surgery today.
Please indicate your preference:
_____ I elect to have the pre-anesthetic blood work performed on my pet.
_____ I decline to have the pre-anesthetic blood work performed.
Are there any additional services that you would like performed today:
_____ Please perform a heartworm test on my dog prior to surgery $28 (If pet not tested recently and you decline, you will need to sign a waiver)
_____ Please scan my pet, if no microchip is found, please permanently identify with a microchip $20
_____ Please complete a urinalysis (recommended in dogs over 7 years of age or older) $32
_____ Please take chest x-rays to detect any hidden lung/heart disease. $95
_____ Please trim my pet’s nails. Up to $14
_____ Please clean my pet’s ears. $19
_____ Please express my pet’s anal sacs. $17
_____ Please apply Soft Paw nail caps to my cats toe nails. Circle Preference: Front paws $22 OR All 4 paws $40
_____ Please check my pet for the following health issue or concern (cost will vary) _________________________________________________
____________________________________________________________________________________________________________________
I, the undersigned, do hereby certify that I am the owner/duly authorized agent for the described animal, and I authorize and request
the services listed on this form. I hereby authorized the performance of professional accepted general anesthetic procedures
necessary for this treatment. I understand the nature of the procedures and the risk involved. I understand, and accept that when
general anesthesia is involved, there are always inherent risks, including death. I realize that the results cannot be guaranteed.
I understand the services/treatments not listed on the estimate are not included and will incur additional charges if performed. I
understand that the veterinarian will try to contact me if further treatment is recommended. If I am not available, no further treatment
will be completed and my pet will be recovered from anesthesia. I have indicated any additional services I would like performed with
a check mark or my initials above. I understand that pain and/or anti-vomiting medication will be provided if deemed reasonable. I
understand that I will be charged for flea medication and a dose will be applied if evidence of fleas is found on my pet
today.
I can definitely be reached at the following phone number(s) today: ________________________________________
Owner/Agent Signature: ______________________________________________________ Date:_______________