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  • I, the undersigned owner or agent of the owner of the cat identified above, certify that I am _______ , I am not _________ (Check one below) eighteen years of age or older and authorize the veterinarians at this practice to perform the above procedure(s). I understand that some risks always exist with anesthesia and/or surgery and that I am encouraged to discuss any concerns I have about those risks with the veterinarian before the procedure(s) is/are initiated. While I accept that all procedure(s) will be performed to the best of the abilities of the staff at this clinic, I understand that veterinary medicine is not an exact science and that no guarantee or warranty has been made regarding the results that may be achieved.
  • (Initials)

  • (Initial) Cats can vomit food under anesthesia and inhale into their lungs causing death.
  • Feline Leukemia/Feline AIDS tests


  • A microchip is inserted under the skin on the back of the neck. This chip registers you and your cat’s information and also allows for us to scan your cat’s temperature without a thermometer. If your cat is lost, a shelter or veterinary hospital is required to scan for a chip prior to adopting out or euthanizing. The cost for this procedure is $56.50 + tax

    (for lump/tumor removals only)

  • (Initial)

    In the event the doctor recommends an overnight stay (spays, declaws, cystotomy etc.), I understand that continuous presence of personnel is not provided during those hours.


  • I acknowledge that I am responsible for payment in full for the above procedure and treatments at the time my cat is discharged.
    If your cat is being hospitalized for treatment or non-routine surgery, a $200.00 deposit is required.
    I further agree that I, or an authorized agent, will pick up this cat and pay for all accrued charges within five days of receiving written or oral notification that my cat is ready to be released. Such notice will be given at the phone/address maintained on the clinic’s patient/client record. I understand that if I fail to comply with this policy, the practice will handle this as an abandonment case, and I will be responsible for all fees incurred.
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