Pet Neuter/Spay Agreement
Use this form to provide owner details, pet information, medical screening, scheduling preferences, and agreement to the neuter/spay procedure and care instructions.
Owner Information
Owner/Guardian Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Preferred Contact Method
Phone
Email
Text
Pet Information
Pet Name
*
Species
*
Dog
Cat
Other
Breed
Sex
*
Male
Female
Date of Birth
-
Month
-
Day
Year
Date
Weight
*
Behavior or Handling Notes
Medical and Surgical Screening
Current medications
None
Prescription medications
Over-the-counter medications
Supplements
Herbal products
Other
Known allergies
None known
Medication allergy
Food allergy
Environmental allergy
Surgical scrub/latex sensitivity
Other
Previous surgeries or anesthesia events
No previous surgeries
Previous surgery without issues
Previous anesthesia with concerns
Recovery complication
Unknown
Other
Any history of anesthesia problems?
No
Yes
Unknown
Current illness or symptoms
None
Coughing or sneezing
Vomiting or diarrhea
Lethargy
Loss of appetite
Fever
Other
Is the pet pregnant or possibly pregnant?
No
Yes
Not sure
Not applicable
Veterinary clinic or referring vet name
Additional medical details
Procedure Scheduling
Preferred Procedure Date
*
-
Month
-
Day
Year
Date
Preferred Drop-Off or Appointment Time
Hour Minutes
AM
PM
AM/PM Option
Scheduling Preference
First Available
Morning
Afternoon
Flexible
Other
Send Pre-Op Instructions By
Email
Text Message
No Preference
Acknowledgment and Agreement
Owner/Guardian Signature
*
Signature Date
*
-
Month
-
Day
Year
Date
Submit Agreement
Submit Agreement
Should be Empty: