Pet Registration Form

How did you hear about us?

Are you scheduled for a free surgery?
YesNo


Client Information:


Pet's Information:

Pet Type: CatDog
Pet Gender: MFUnknown

Where does this pet spend the most time?
OutsideInside


Procedure Authorization:

Please read thoroughly, check the boxes if you agree and sign below.

I understand that some factors significantly increase surgical risk, including, but not limited to, pregnancy heat, and diseases such as feline immunodeficiency virus (FIV), feline leukemia (FeLV), and heartworms.

I understand that PAAC is not a full-service veterinary hospital, and that my pet will only receive a brief pre-operative examination from a PAAC veterinarian to assess my pet’s general health and eligibility for surgery.

I understand that the operation I have elected presents some hazards that may conceivably result in injury or death. I understand, as with all surgical procedures, there is some risk in the procedure and some risk in use of anesthetics and drugs provided for the procedure. In the event of injury or death, I will not hold PAAC, its employees, directors, officers, volunteers, or contractors accountable. I acknowledge that it is my responsibility to provide appropriate aftercare for my pet and seek medical attention if necessary.

If my companion animal has medical complications relating to surgery, I understand and accept that it is my responsibility to contact PAAC before obtaining any other veterinary care for my pet. If subsequent care is required as a result of individual pet problems – such as licking at stitches, pre-existing conditions, etc. – it will be at my expense.

I understand that if my pet is found to be flea-infested, he/she will be treated at my expense.

I confirm that I am over 18 years of age.

I certify my animal has not bitten anyone to my knowledge within the last 10 days.
Signature:
Date: