Terms:
I acknowledge that no guarantees or assurances have been made to me regarding the results of the surgery.
I understand the risks involved in my animal’s surgery and that injury to, death of, or post-operative infection may occur. I understand that my animal(s) will be placed under general anesthesia. I assume full responsibility for the consequences that may arise. I understand and accept these risks to my animal.
To my knowledge, this animal(s) is in good health. I verify that, to my knowledge, this animal(s) does not have a previously diagnosed condition. I verify that my animal(s) has not been vomiting, sneezing, coughing, and/or experiencing diarrhea within the past two (2) weeks.
I verify that this animal(s) has been fasted for at least 10 hours prior to surgery (with the exception of animals under 4 months of age). I understand that anesthesia and sedative drugs may cause stomach upset resulting in vomiting. Vomiting increases the risk of aspiration of stomach contents into the animal(s)’ lungs that may result in aspiration pneumonia. I understand that ROCKWALL ADOPTION CENTER is not responsible for complications resulting from failure to fast my animal(s).
I understand that ROCKWALL ADOPTION CENTER is not responsible for complications resulting from my request to release my animal(s) while still showing signs of sedation, complications resulting from my failure to follow post-operative instructions, and complications resulting from my failure to keep my animal(s) indoors for at least seven (7) days after surgery.
I understand that there are inherent risks in failing to maintain current vaccinations. ROCKWALL ADOPTION CENTER recommends that animals be vaccinated two (2) weeks prior to surgery. ROCKWALL ADOPTION CENTER is not responsible for contagious diseases contracted after surgery for which the animal was not previously vaccinated, including, but not limited to, kennel cough. I am responsible for the cost of treatment.
I understand that if my animal(s) is a good surgical candidate and is pregnant at the time of surgery, the pregnancy will be terminated.
I understand that I MUST pick up this animal(s) on the date and time indicated by ROCKWALL ADOPTION CENTER personnel. Failure to pick up my animal(s) by 6:00pm on the day of surgery will result in an overnight charge of $40 with an additional $40 charged for each day after that. Failure to pick up my animal(s) after 72 hours, will result in my animal(s) being turned over to the Rockwall Adoption Center for abandonment. Charges of abandonment are punishable as a class A Misdemeanor, up to $4,000 in fines and 1 year in jail.
I understand that there is risk of a moving vehicle accident when my animal is being transported to the clinic and hold ROCKWALL ADOPTION CENTER and its driver harmless from any liability resulting from any such accident.
To the best of my knowledge, this animal(s) has not bitten any person during the past fifteen (15) days preceding the date of this consent form.
I will provide my animal(s) with a clean, dry, indoor environment for recovery. I will provide post-surgical monitoring and care in accordance with the Post- Operative Instructions provided to me.
I understand that if my animal dies, the animal will be picked up by me, or the remains will be disposed of in accordance with state laws and the policy of ROCKWALL ADOPTION CENTER.
I understand that I am responsible for paying all costs of services rendered, including any CPR drugs, the cost of keeping and/or disposing of animals. I understand that the services initialed herein will be included in my final invoice.
I understand if I order any additional services or the veterinarian on duty performs any additional treatments or procedures (including but not limited to the removal of retained deciduous teeth that he/she feels are important to the animal’s health and safety at the time of surgery), I am responsible for payment of such services.
I understand that additional charges may be incurred if my animal(s) is pregnant, in heat or has undescended testicles.
I understand that all services rendered today will be payable via the credit card on file and will be charged prior to patient discharge. Please include name(s), age(s), color(s), and breed(s).
I understand that it is my responsibility to contact the clinic with alternate card information to be used by 10am on the date of any scheduled appointment.
I hereby acknowledge and agree that should any complications or issues arise between me (or any others with a personal interest in my animal(s), including my spouse, family members, co-owners, etc. ("Other Interested Parties") and ROCKWALL ADOPTION CENTER, I will work (and ensure that Other Interested Parties will work) only with ROCKWALL ADOPTION CENTER management in person or by telephone to timely and mutual resolution. In such event, I will not disparage, nor will I allow any Other Interested Parties to disparage, ROCKWALL ADOPTION CENTER or any of its officers, directors or employees, in any public forum including social media and internet review websites or applications. For purposes of this section, “disparage” shall mean any negative statement, whether written or oral, about ROCKWALL ADOPTION CENTER.
Promotional Materials:
Your signature below allows ROCKWALL ADOPTION CENTER to use you and/or your animal's picture in promotional material.
Independent Veterinarians
I acknowledge that the veterinarians treating my animal(s) do not work for ROCKWALL ADOPTION CENTER. The veterinarians are engaged in the private practice of veterinary medicine and are not employees or agents of ROCKWALL ADOPTION CENTER. ROCKWALL ADOPTION CENTER is not responsible for the judgment or conduct of the veterinarians who treat or provide services to my animal(s). ROCKWALL ADOPTION CENTER does not exercise control of any nature over any procedures performed by the attending veterinarian, and I will not hold ROCKWALL ADOPTION CENTER, its staff, volunteers, or agents liable or responsible in any manner for any complications that may arise during surgery or as a result of the surgery.
The veterinarian may perform additional treatments or procedures that he/she feels are important to the health of the animal(s). These additional treatments or procedures are beyond the scope of ROCKWALL ADOPTION CENTER’s services and additional charges may apply.
The veterinarian may also refuse to perform any procedure on any animal for any reason. Such refusal is at the sole discretion of the attending veterinarian. I also understand and acknowledge that ROCKWALL ADOPTION CENTER may refuse to accept any animal that, in its opinion, could jeopardize the safety of any other animal or person. For any animal declined for medical or safety reasons, you will be charged at least $20 per animal for the exam plus charges for all other services and medications provided.
Your cat will be given a pain control medication today that lasts for approximately 24 hours. Some cats may experience pain beyond 24 hours. You may purchase additional pain medication to take home for an additional fee.
A pre-anesthetic FeLV/FIV test is recommended before elective surgeries. This disease can lead to severe complications, and even death, under or after anesthesia/surgery.
For the health and welfare of my cat, I understand that ROCKWALL ADOPTION CENTER strongly recommends that I purchase an e-collar to aid in the prevention of contact (including licking) of any incision site, which if not prevented by me, can cause post-surgery issues.
By signing below. I hereby confirm that: (i) I am the Owner or representative authorized to make decisions on behalf of the animal(s) listed in this document, (ii) the services and procedures to be performed have been fully explained to me to my satisfaction, and (iii) I have read, understand, and agree to the contents of this document.
