CCHS FixaPet Program Consent and Waiver of Liability
I authorize FixaPet to perform the spay/neuter surgery and the services chosen on the Admission Form, including the use of anesthetic. To my knowledge the animal has no medical problems which may cause this surgery to be inadvisable.
I agree that all post-operative care is my responsibility. The cost of post-surgical medications (e.g. antibiotics) and devices (e.g. Elizabethan collars) is not included in the charge for surgery. If it is determined by the attending veterinarian or FixaPet staff that post-surgical medication or devices are needed, the individual consenting to this form agrees to be responsible for the additional cost incurred. It is the owner’s responsibility to ensure that a pet does not remove its stitches. If resuturing is needed, there will a minimum $20.00 fee.
I understand that animals undergo a cursory preanesthetic exam (except feral/fractious animals) but not a blood screening. I agree to indemnify and hold harmless: the FixaPet program (including its’ agents, employees, volunteers and any assisting staff thereof); the Clark County Humane Society (including its’ officers, agents, employees, volunteers and any assisting staff thereof); the attending veterinarian (and the associated corporate entities and officers as well as the employees and staff) from any and all liability, including injury, complications, sickness and death, that may arise out of the performance of any or all procedures performed on the animal as part of the FixaPet program.
Each cat must be in a separate carrier or live trap. (Cardboard boxes are not acceptable.) Dogs must be securely collared and leashed. Animals must be under control. Pets deemed to be a danger to handle, too ill or medically unfit, pregnant or in heat may be refused. If the vet feels that surgery can safely be performed on a pet in heat or pregnant there is an additional $10.00 charge. “In heat” status will be determined by the doctor at the time of surgery. There will be a minimum charge of $10.00 if it is determined, prior to surgery, that a pet has previously been spayed. There will be an additional $20.00 anesthetic fee for dogs weighing more than 60#, $25.00 if over 80#, and $30.00 if over 100#.
FixaPet will make every attempt to complete the surgery on your pet on the specified date. We can not be held responsible for any factors that may necessitate rescheduling or cancelling the surgery.
I agree to pick up my animal at the time specified. I understand that if I fail to do so I will be liable for additional fees of $50.00 per day. I understand that if I have not picked up my animal at the time specified and two more days have passed, the animal will be considered abandoned, custody will transfer to the Clark County Humane Society and I will still owe the $100.00 late pick-up fee.
We insist on the respectful treatment of all people, property and animals associated with our organization. We will refuse future services to anyone who engages in inappropriate treatment of the aforementioned entities. Fees for spay/neuter surgery and any other additional fees must be paid at time of pick-up. No animal will be released without payment being made. Payment may be in cash or by credit/debit card. No checks accepted.
I have filled out the Admission/Services form and understand the terms and charges for services as presented. I have read, understand, and have been fully informed of the terms and agree to be bound by the above conditions and I am willingly signing this consent and waiver of liability.
If I can’t bring my animal to FixaPet, I hereby authorize _________________________as my agent.
Is your pet taking any medications? Yes No Has your pet had flea/tick preventative? Yes No
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Signature of legal owner Date Agent Signature (if needed) FixaPet Staff