I, acting as owner or agent of the pet named above, hereby request and authorize SNVC to perform an operation for sexual sterilization of the animal named above.

I understand that any anesthetic/surgical procedure, including surgical sexual sterilization, presents a degree of risk to the patient and, though minimal, may result in injury or death.

I certify that my animal is in good health and not on any medications other than those disclosed.

I understand the inherent risks of failing to maintain current vaccinations and waive all claims arising out of or connected with the performance of this operation or due to such failure.

I understand that some factors significantly increase surgical risk, including but not limited to; pregnancy, being in heat, recently post-partum, obesity, brachycephalic or over seven years in age, having a heart murmur, and diseases such as Feline Immunodeficiency Virus (FIV), Feline Leukemia, and heartworm disease.

I understand that blood work and/or veterinary diagnostic prior to surgery is recommended for all high-risk pets.

I understand that if my pet has a pre-existing medical condition, clinical or subclinical, this condition may be worsened by anesthesia and/or surgical sterilization.

I understand that if my animal is pregnant, the pregnancy will be terminated at the surgery.

I understand that SNVC has the right to refuse service to any animal determined to be ill or at increased risk. Sick animals are at higher risk for anesthetic and surgical complications, as well as pose a risk to other animals in the Clinic.

I understand that SNVC may not perform a complete physical examination before surgery is performed. I also understand that my animal will not receive pre-operative blood work and waive my right to have this service performed prior to surgery.

I understand that if there are complications, my pet may need to receive post-operative monitoring or care at an emergency clinic, and I accept the financial responsibility for that care if deemed necessary by the veterinarian.

I understand that my animal should have no food after 12:00 midnight the evening prior to surgery (excluding pets less than four months old).

I understand that if my animal has an open umbilical hernia, it may be repaired at the time of surgery for an additional fee.

I understand that if my male animal is a cryptorchid, there will be an additional fee for surgery.

I understand that photographs may be taken during the day, and my pet may be present in those photos. I understand that the photographs taken at SNVC may be used for promotions and advertisements for SNVC. This includes but is not limited to Facebook, Twitter, SNVC website, advertisements, etc.

I understand that if I do not retrieve my pet at the agreed-upon time, SNVC may exercise their right to turn the animal over to the nearest animal control center, humane society or dispose of it as deemed just and proper as allowed by the State of North Carolina under G.S. 90-187.7(a). Owners of pets left after closing at 5 pm will be charged a 25.00 per hour late fee. Owners dropping Pets off past the intake time of 8:00 am will be charged a 25.00 late drop-off fee and may be turned away for surgery and asked to reschedule.

I understand that payment in full is required prior to services being rendered.

I understand that under no circumstances will the Spay Neuter Veterinary Clinic pay for services received at another veterinary clinic, whether the services are related to a surgery done at the Spay Neuter Veterinary Clinic or not.

I understand that there will be a small permanent green line tattoo next to the incision indicating sterilization.

I understand that my animal may receive a nail trim.

I understand that my animal's fur will be shaved to ensure sterility during the surgical procedure.

I understand that if the Clinic has any questions regarding your pet or there is reason for concern or increased risk with surgery noticed prior to or during surgery, the Clinic will attempt to reach the owner at the numbers left at check-in. IF THE OWNER IS NOT REACHABLE BY 10 am DAY OF SURGERY, I UNDERSTAND THAT SURGERY MAY NOT BE DONE ON MY ANIMAL, and you may need to reschedule your appointment.

I hereby release the Spay Neuter Veterinary Clinic of the Sandhills, all veterinarians, assistants, volunteers, directors, and employees from any and all claims arising out of or connected with the performance of this procedure or any adverse reactions from vaccinations. I agree that I have not and will not claim any right of compensation from any of the above or file action by reason of such sterilization or attempted sterilization of such animal or any consequences related thereto. Owner/agent hereby agrees to hold SNVC unaccountable for any damages caused during the transportation of the animal or for any damages caused by any unforeseeable events, including fire, vandalism, burglary, extreme weather, natural disasters, or acts of God.