Pawsitive Action Foundation, Inc.
Saint Cloud, Fl 34771 407-803-3381
INFORMED CONSENT & DISCLOSURE FOR SPAYING, NEUTERING or other Veterinary Procedures
· Any anesthetic and surgical procedure carries inherent risks of complications. While rare, (less than one
in a thousand), serious complications including but not limited to: infection, bleeding, allergic reaction,
cardiac arrest, and death – do sometimes occur.
Additionally, pets sometimes damage their incisions due to licking, chewing, and/or over activity. I accept
this risk, and understand that I am responsible for the costs of treating any complications.
· The risk of serious complications can be minimized, (but not eliminated), by having pre-anesthetic
screening tests done to detect some, (but not all), unknown underlying medical conditions. Pre-anesthetic
bloodwork and chest X-Rays and EKG’s can be done at nearby larger hospitals. Fees need to discussed
with those hospitals. Please advise the nurse if you would like to discuss or arrange for pre-anesthetic
testing.
We can provide pre-anesthetic blood work if your pet is brought in to the clinic the previous THURSDAY
before your pets surgery. Call for prices.
· The risk of complications can be further minimized, (but not eliminated), by certain services that we
cannot provide within our fee structure. These services include, but are not limited to: complete physical
examinations, placement of IV catheters, IV fluid administration, blood pressure monitoring, and/or
constant EKG monitoring. Most veterinary hospitals do not provide these additional services. Those that
do will typically charge a minimum of an additional $100 to $200 to cover the costs involved. If you wish to
explore the availability and costs of such additional services, we understand your concerns and will be
happy to cancel your appointment.
· It is assumed that patients presented for surgery are in good health. Time constraints do not allow us to
perform complete physical examinations on all patients prior to surgery.
· I certify that this pet(s) has current vaccinations and does not have heartworms (dogs) or feline leukemia
(cats); or if not, I accept the increased risk of complications resulting from failure to vaccinate and test. Be
aware that it may take up to two weeks for vaccinations to protect your pet. Heartworm tests ($25),
Leukemia test ($25) are available upon request.
· I certify that this adult pet(s) has not eaten any solid food since midnight last night, or if not, I accept the
increased risk of complications that can arise from aspiration while under anesthesia.
· Pregnancy, being in heat, excessive milk, obesity, previous c-sections, or retained testicles may
complicate surgery, extend recovery, require additional after care, and additional charges may apply.
Cats that are obese, pregnant, having a false pregnancy, having had a previous c-section, or have milk
engorged breasts - up to $25.00
Dogs that are obese, in heat, pregnant, having a false pregnancy, having had a previous c-section, or
have milk engorged breasts - up to $35.00
Retained testicles in dogs or cats - up to $50.00 per testicle
*Charges are determined by the doctor during surgery and are based on additional time and supplies
required.
· Pregnant animals will be spayed, which will terminate the pregnancy.
· I understand that I cannot allow my female pet to nurse kittens/puppies following surgery.
· I understand that I cannot allow my female pet in heat to be bred following surgery.
· I understand that I cannot allow my male pet to breed following surgery.
· If a pet has already been spayed or neutered, the REGULAR FEE will apply to cover the cost of
anesthesia, nursing care, and boarding.
· If a pet is infested with fleas and/or ticks he/she will be treated in order to prevent other pets in the clinic
from becoming infested, at a charge not to exceed $15.00.
· If my pet requires antibiotics due to excessive milk or any underlying infection, I will be responsible for the
charges.
· If I ask for any additional surgical procedure, physical exam, medical treatment, testing, vaccinations,
medications, etc. I will be responsible for the charges.
· We will not allow cats to leave this clinic following surgery unless he/she is in some type of a cat carrier,
no exceptions.
· If my pet rips, tears, licks, or chews open his/her incision following surgery, I will be responsible for all
charges resulting from additional surgery, hospitalization, medications, etc. I understand that the clinic is
only open on Thursdays by appointment only.
*Elizabethan (lampshade) collars are available at any pet supply warehouse and should be used if the pet
is overly interested in his/her incision site.
· Payment in full is due at CHECK IN, no exceptions. All pets MUST be picked up from the clinic by 6 PM
day of surgery.
We accept cash or Credit Cards Only. No checks please.
. If your pet is not picked up by 6 pm we will consider it ABANDONED. Your pet will be taken to Osceola
Animal Control.
· I am the owner or agent for the owner of this pet. I am 18 or older.
I have read and understand this authorization and consent. I consent to and authorize the spaying or
neutering of this pet. I hereby release Pawsitive Action and their staff, employees, owners, directors,
officers, & volunteers from any and all claims arising out of or connected with the performance of this
operation or procedure.
___________________________________________ Pet's Name
____________________________________________Owner's Signature
________________________ Date