Are you currently a client of Campbellville Animal Hospital? *

I am currently a client
I am not a current client

Your full name *

First

Last

What is the best phone number to reach you at? *

What is your home address? *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

What is your email address? *

Pet Name *

Pet Species *

Pet Breed *

Pet Color *

What sex is your pet? *

Male
Female

Does your pet have a current veterinarian? *

Yes
No

a provided currently

If yes, please specify: *

What is your pet’s date of birth? An estimate is acceptable if over 1 year of age *

What is the approximate weight of your pet? *

Does your pet have any known medical issues? *

Is your pet on any medications? *

Yes
No

If yes, please specify: *

Is your pet up to date on the Rabies vaccination? If yes, Please email a copy of the pet’s rabies vaccination certificate to petcare@campbellvillevet.ca *

Yes
No

Has your pet had any reactions to medications or vaccinations in the past? *

Yes
No
Unsure

(MALES) Do you know if both testicles have descended? *

Yes
No
Not Applicable

(FEMALES) When was your pet’s last heat cycle? Please write N/A if they have not completed a heat cycle. *

Has your pet ever had a litter? *

Yes
No

If yes, please specify when was the last litter? *

(CATS) Does your cat go outdoors? *

Indoor
Outdoor
Not applicable

I understand that pre-anesthetic bloodwork is recommended prior to any surgical procedure but that it is not required or included as part of the low cost program. Pre-anesthetic bloodwork is $150.95 + HST additional. If I wish to have pre-anesthetic bloodwork I understand that I will be required to schedule a time to come into the clinic with my pet at 3-5 days prior to the surgical date. *

I would like pre-anesthetic bloodwork
I decline pre-anesthetic bloodwork

I understand that I will be emailed consent forms to the email I provided to review, sign and bring in on the surgery date or email back to CAH. I understand if I cannot print these at home I will be required to fill them out the morning of surgery. *

I accept

I understand a $100 deposit is required at time of booking for spay/neuter. I understand that the full balance is owed at the time of service. *

I accept

I understand the $100 deposit fee is non-refundable *

I accept

I understand that if my pet has not been seen by CAH prior to the surgical date my pet may fall into a different weight category than anticipated and the cost could be greater.(Please review pricing chart on our website) *

I accept

I understand that when the form is submitted I will be contacted to schedule surgery & take the deposit payment over the phone. *

I accept

I understand and accept that while my pet is in the clinic, photographs and videos may be taken of them. These photos and videos may be used for social media, advertising or marketing purposes. *

Accept
Decline

I have read, understand, and agree to all the statements below.

I accept and understand.

I understand the veterinarian can decline surgery on my pet without any reason.
I understand that if my pet is deemed aggressive, I may be called back to the clinic to retrieve my pet without services completed.
I understand that if my pet is found to be pregnant, there will be an additional fee and the pregnancy will be terminated if discovered while in surgery. For cats, this fee is $150 + tax, for dogs this fee is $250+tax.
I understand that if my pet is found to have a pyometra(infection of the uterus) there will be an additional fee. For cats, this fee is $100+tax, for dogs this fee is $200+tax.
I understand that if my dog is found to be in heat during the pre-surgical exam, surgery will be cancelled and the deposit fee will be held. I understand that my pet will be rebooked to the next appropriate date in the future.
I understand that my pet is required to fast starting 8 hours before drop off for surgery. They will be required to have no food during this time. If they are fed a meal after this time, the surgery may be declined.
I understand that the drop off time for the procedure will be between 8am and 830am, a specific time will be scheduled during your booking phone call.
I understand that it is always recommended to book a follow-up for my pet with their regular veterinarian following surgery.

Signature *

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Hours

Low Cost Spay & Neuter Enrollment Form

Making Sure Your Pet Is Ready for Surgery

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