ANIMAL SHELTER SOCIETY, INC.
Veterinary Facility
License # Fac 8
Spay/Neuter Packet
Please complete this form and remit with payment made payable to:
Animal Shelter Society, Inc.
1430 Newark Road
Zanesville, Ohio 43701
Telephone: 740-452-1077
Once payment is received you will be contacted to schedule your pet’s surgery.
Name: _______________________________________________________
Address: ______________________________________________________
City: ___________________________ State: ____________ Zip: _________
Telephone: (Daytime) ________________ (Evening) ____________________
Email: ________________________________________________________
Pet’s Name: _______________________ Approximate Age: _____________
Dog: __________ Cat: ___________ Male: ________Female:_____________
Breed Type: ______________ Color: _______________ Coat: Long or Short
Canines - Proof of current Parvo/Distemper combo and Bordetella vaccination required at
least 7 days prior to surgery. Rabies vaccination is required by Ohio State Law for dogs
over 4 months of age and may be given at the time of surgery.
Felines - Proof of current HCPCh (RCCP) vaccination is required prior to surgery.
Additionally, rabies vaccination, leukemia test and leukemia vaccination are strongly
recommended for outdoor cats.
If your pet has fleas, you will be charged $8.00 for a capstar.
Animal Shelter Society, Inc
Veterinary Facility
Patient Check-in Information
Owner's Name____________________________Patient's Name_____________________
Telephone number where we can reach you today :(______) _________________
How long have you owned this animal? __________________________________
Has your pet displayed any of the following in the last 2 weeks: (check if yes)
Sneezing_____
Coughing_______
Vomiting______
Diarrhea_______
Has your pet ever had a seizure? Yes_____ No____
If yes, explain: ____________________________________
If your pet is female:
When was her last heat cycle? ______________ Unsure_______
Has she had any litters? Yes_____ No ____ If so, when was last time? ________
Is your pet pregnant? Yes_____ No____ Could be____
Has your pet had any previous (Please explain)?
Illness? _____________________________________________
Injuries? ____________________________________________
Surgery? ____________________________________________
Drug or vaccine reaction? _______________________________
Is your pet on any long-term medication? Yes___ No ___
If yes, list all _______________________________
Has your pet been given any medication in the last month? Yes___ No ___
If yes, list type and why it was given_______________________________________
Has your pet been treated or dipped for fleas/ticks in the last month? Yes__ No__
If yes, what product was used? _________________________
When was the last time your pet was:
Heartworm tested? ___________ Not tested ______ Unsure if has been____
Leukemia/FIV tested? _________ Not tested ______ Unsure if has been ____
Is your pet on monthly heartworm prevention? Yes____ No _______
If yes, what type? Heartguard
Interceptor/Sentinel Revolution
Iverheart
Client/Agent Signature________________________________ Date: ___________________
The Animal Shelter Society, Inc.
Surgery Release of Liability
THIS IS A GENERAL RELEASE OF ALL CLAIMS BY PET OWNERS.
The agreement made on __________________________by and between_________________________
Date
Owner’s Name
hereafter referred to as “Owner” and the Animal Shelter Society, Inc., of Zanesville, Ohio, hereafter
referred to as “Shelter”, is a release whereby the owner extinguishes his/her rights and claims against the
“Shelter”, shelter employees and veterinarian as herein enumerated.
Now, therefore, with intent to be legally bound and in consideration of the release performing certain
surgical services for the owner.
The owner agrees as follows:
1.) The owner, on behalf of himself, his heirs, executors, administrators, and assigns
hereby fully releases and discharges release and its assigns and successors from
all rights, claims and actions which the owner and his above mentioned successors
now have or may have after the signing of this agreement against the shelter and
its above mentioned successors arising out of a surgical procedure of any animal or
any pet of the owner.
2.) This release is intended by the parties to release all injuries, damages or losses to
the owner whether known, unknown, foreseen, or unforeseen, including death,
termination of pregnancy, or complications resulting from a surgery, also which owner
may have against the shelter or the shelter’s on staff veterinarian. The owner further
acknowledges that the shelter shall not be responsible for services rendered by any
veterinarian, before or after the surgery. The owner understands and acknowledges the
significance and consequences such specific intention to release all claims and hereby
assumes full responsibility for any injuries, damages or losses that he/she may incur from
the above mentioned services provided.
3.) This release is freely and voluntarily executed by the owner after having been
apprised of all relevant information and data. The owner in executing this release
does not rely on any inducements, promises, or representations made by the shelter,
its representatives, or employees.
4.) The owner has read this release and had the terms used herein, in the consequences
thereof fully explained to him/her by the employees, or a member of the Board of
Trustees of the Animal Shelter Society, Inc.
Signed Owner: ___________________________________________________________
Signed Shelter Employee: _____________________________________________
ANIMAL SHELTER SOCIETY, INC.
VETERINARY FACILITY
License # Fac 8
INSTRUCTIONS BEFORE THE SURGERY
Food and Water: Do not give your cat or dog food after 10 P.M. the night before surgery and
do not give it any food or water the morning of surgery.
Prescription Medication: If your pet is on any medication other than heartworm pills ask your
veterinarian or call us prior to the surgery date to determine if the medication should be given the
morning of the procedure.
Nursing Animals: Lactating animals should not nurse for at least 2 weeks before the day of
surgery. The animal’s litter should be between 6 and 8 weeks of age and eating and drinking on
their own prior to spaying the mother.
Pediatric Surgeries: Pets must be at least 4 months of age for spay and neuter. If your pet is
less than 4 months, you must bring him/her back at a later time. No Exceptions.
Heartworm Prevention: Heartworm prevention should be administered as normal, regardless
of the surgery date.
Restraining Your Pet: All dogs must be on a leash and cats must be in a pet carrier.
An Appointment has been scheduled for your pet’s spay/neuter operation for:
_______________________________________
Your pet will need to arrive at the Animal Shelter between 8:00 and 8:30A.M. You will need to
report at the front desk through the main entrance. All pets must be picked up between 4:15 and
5:00 P.M. the day of the surgery.
Thank you and if you have any questions please contact the Animal Shelter at:
740-452-1077
If your pet has fleas, it will be given a Capstar and you will be charged $8.00 when you pick
up your pet.
The Animal Shelter Society Inc.
1430 Newark Road
Zanesville, OH 43701
Phone: (740) 452-1077
Post Surgery Instructions
Your Pet will be excited upon seeing you which calls for special attention.
As your pet leaves the shelter he will at once be confronted with your welcome, a car ride which may give
rise to a bit of motion sickness, the overly stimulated sights, sounds, and smells of home, and a possible
surplus of food and water. Too often the animal leaps and races, gulps food and water beyond its capacity,
and ends up with a case of nervous vomiting or diarrhea. In order to avoid these conditions and to provide
for the comfort of your pet and you peace of mind, you will find these suggestions helpful:
Proper restraint: To protect your pet when leaving the shelter, proper restraint (leash or carrier) is important.
Sudden lunging or jumping might result in your pet getting loose or worse; result in injury if it is recovering from
surgery.
Limit food & water intake: Excessive gulping of food and water can lead to stomach upset. Give your pet small
amounts of food and water until it had adjusted to normal home life.
Control exercise: To show his happiness at being home, your pet will want to run and jump. It is best to
discourage excitement by restricting its play. Following surgery, outdoor exercise during the first 10 days should
be restricted to walking on a leash.
Stairs: Keep pets away from stairs until fully awake to avoid falls.
Chewing & licking: DO NOT allow your pet to lick or chew at its sutures or surgery site. Purchase an E-Collar.
Cat surgery: Your cat should have shredded paper litter for at least 10 days following surgery. Do not let your
cat jump from counters or other furniture.
Medicine time: Your pet may be sent home with medication. If medication is sent home for your pet, it is
important that you administer on time and in the amounts directed.
Bath time: DO NOT bath your pet for at least 10 days after the date of surgery. The date of surgery can be found
on the health record provided for you at the time your pet leaves the hospital.
Suture removal: If your pet has sutures they need to be removed two weeks from the surgery date. This
information can be found on the health record provided at time of departure from the shelter.
Puppy love: Although your pet has just been neutered doesn’t mean that a neutered male will not try to mount a
female, or male dogs may try to mount a spayed female. Do not let this happen for this could cause serious injury
or even result in death if the pet is not fully healed inside and out. Keep your pet on a leash at all times when not
in the house.
If you will follow these simple rules, you will best protect your pet’s well being and his homecoming will be a
pleasant experience for everyone.
Thank you for having your pet spayed or neutered and helping to keep the pet population under control.
Owner Signature:_________________________________________________ Date_______/______/_____
ANIMAL SHELTER CANINE REGISTRATION FORM
SERVICES
Dog Spay:
Up to 60 Pounds
Dog Neuter:
95.00_____
Up to 60 Pounds
75.00_____
Any Canine over 60 pounds will require price Quote by Veterinarian_________LBS
$________
In Heat
Minimum 20.00__________ (Additional fee possible)
Pregnant
Minimum 35.00 _________ (Additional fee possible)
Crypt orchid Males
(Retained Testicles)
Minimum 30.00__________ (Additional fee possible)
Umbilical Hernia Repair
(Protruding Belly Button) Minimum 20.00__________ (Additional fee possible)
Note: There is $25.00 sedation/anesthesia fee for pets that are found to be
already spayed/neutered following sedation and without surgical exploratory.
Vaccinations: (The following prices are available only when receiving spay/neuter services)
DAPPv only
DAPPv+L4 only
Rabies only
Bordetella
(Kennel cough)
DAPPv, DAPPv +L4,
Rabies & Bordetella
Package
11.00
11.00
11.00
Ear Cytology
8.00
Heartworm Test
15.00
Capstar
Microchip
8.00
20.00
11.00
25.00
Misc.__________________________
TOTAL COLLECTED: __________________
DATE OF SURGERY: ___________________
RECEIPT NUMBER: ___________________
All pet owners are required to provide proof of current 5-way, rabies and bordetella
vaccinations for your pet. Bordetella should be administered at least 7 days prior to
surgery. Other vaccinations may be administered the day of the surgery.
ANIMAL SHELTER FELINE REGISTRATION FORM
SERVICES
Feline Spay
60.00_______
Feline Neuter
40.00_______
Pregnant/In Heat
Minimum 20.00________ (Additional fee possible)
Cryptorchid Males
(Retained Testicles)
Minimum 30.00________ (Additional fee possible)
Umbilical Hernia Repair
(Protruding Belly Button)
Minimum 20.00 ________(Additional fee possible)
Declaw Only (front feet Only)
< 10 lb 105.00 ________
>10 lb 125.00 ________
Note: There is $25.00 sedation/anesthesia fee for pets that are found to be
already spayed/neutered following sedation and without surgical exploratory.
Vaccinations: (The following prices are available only when receiving spay/neuter services)
HCPCh (RCCP)
Rabies
Leukemia Vaccination Only
(Must have proof of prior test or
vaccination within the year)
FeLV Test &
Leukemia Vac (<6 months)
FeLV/FIV Test &
Leukemia Vac (>6 months)
FeLV Test only (<6months)
FeLV/FIV combo test (> 6months)
11.00 _______
11.00_______
11.00_______
Capstar
Ear Cytology
Microchip
25.00_______
35.00_______
20.00_______
25.00_______
Misc.______________________________________
TOTAL COLLECTED: __________________
DATE OF SURGERY: ___________________
RECEIPT NUMBER: ___________________
Cats are required to have a HCPCh (RCCP) vaccination.
8.00
8.00
20.00
ANIMAL SHELTER DENTAL REGISTRATION FORM
Dental prophylaxis and treatment
Dental add on with spay or neuter:
Cats- 35.00 _________
Dogs under 40 lb – 45.00 _________
Dogs over 40 lb – 60.00 _________
Dental only (no spay or neuter)
Cats- 55.00
Dogs under 40 lb- 80.00 _________
Dogs over 40 lb- 100.00 _________
Tooth extractions- 6.00 to 20.00 EACH, based on size of tooth and time required
for extraction.
Additional costs
**** Pets will be sent home with antibiotics if current infection or risk of postdental infection is found. The cost will be based on the size of the pet and the
duration of antibiotics required (= the severity of infection). Cost will range from
$15.00 to $30.00
*****Pain medicine will be sent home if significant tooth extractions are
performed. Cost will be $10.00 to $20.00
*OTHER:
Rabbit spay
95.00_______
Rabbit neuter
75.00_______
*Additional charges may apply if in heat or pregnant.