FixaPet Consent Form

CCHS FixaPet Program Consent and Waiver of Liability

I authorize FixaPet to perform the spay/neuter surgery and services I have selected, including the use of anesthetic. To my knowledge the animal has no medical problems which may cause this surgery to be inadvisable. The surgery today is performed with injectable anesthetic and injectable pain medication. There is always a risk with any surgical procedure involving anesthesia, and FixaPet’s risk of loss is .015%. If receiving any vaccinations today, there is also a chance of vaccination reaction, including bruising and swelling. By signing below I agree that I have been informed of the risks and authorize FixaPet to proceed.

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. 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.

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 $15.00 charge. “In heat” status will be determined by the doctor at the time of surgery. There will be a minimum charge of $20.00 if it is determined that a pet has previously been spayed. There will be an additional $40.00 anesthetic fee for dogs weighing more than 60#, $45.00 over 80# and $50 over 100#.

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. 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 fee.

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 reviewed 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.

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Signature of legal owner or responsible agent Date FixaPet Staff