Canine Surgery Form in Auburn, CA | Animal Spay and Neuter

Canine Surgery Form

Name
First Last
Address*
Mailing Address Physical Address City ZIP / Postal Code
Phone
Email*
Have you ever used this clinic before?*
- Yes
- No
Pet Information*
Name Sex Birthday Breed Color Weight
Is your animal on medication or does he / she have any medical condition we should know about?*
- Yes
- No
If yes, list below:
Date of last Rabies vaccine*
Date of last Distemper vaccine*
FOR ALL ANIMALS: I hereby request Animal Spay & Neuter to surgically sterilize my animal. I have had the opportunity to ask questions regarding the surgery and the risks involved. I understand that there is a risk in any surgery, that no pre-op blood work is offered and that the surgery is performed with a general anesthetic. Not withstanding the risk, I request the surgery. I hereby declare under penalty of perjury that I am the owner, or authorized by the owner, to present for operation the above animal.
Signed:*
My dog is on a monthly heartworm preventative:*
- Yes
- No
Heartworm disease is spread by mosquitoes and is very common in this area. IT CAN CAUSE SERIOUS ANESTHESIA / SURGICAL COMPLICATIONS. Animal Spay & Neuter RECOMMENDS a heartworm test if your dog is not on heartworm preventative medication and is over 8 months of age.
I want a heartworm test for my dog*
- Yes
- No
Heartworm test signature*
Signed:
It is OK to treat my animal for: Earmites, Foxtail removal, Ear flush, Abscess, Cryptorchid if needed (fees vary)

I understand that I must pay for the actual surgery cost at time of the appointment. The payment is NON refundable if I do not show up or cancel at the last minute. I also understand that there may be additional charges for other services.
Treatment signature*
Comments
This field is for validation purposes and should be left unchanged.

As of 4/2/24 we are now closed for all new dog surgery appointments

We do not spay and neuter dogs that are over 5 years of age. We also cannot spay or neuter Dobermans, Doberman mix breed dogs, Pugs, French Bulldogs, or English Bulldogs.

If you have multiple pets, please fill out multiple forms

Please do not expect a callback for 4-6 weeks after you have filled out this form. Please do not call us to ask when your appointment will be. We will call you to schedule your appointment as soon as possible.

Animal Spay and Neuter

A Non-Profit Clinic

Canine Surgery Form

Canine Surgery Form

As of 4/2/24 we are now closed for all new dog surgery appointments

We do not spay and neuter dogs that are over 5 years of age. We also cannot spay or neuter Dobermans, Doberman mix breed dogs, Pugs, French Bulldogs, or English Bulldogs.

If you have multiple pets, please fill out multiple forms

Please do not expect a callback for 4-6 weeks after you have filled out this form. Please do not call us to ask when your appointment will be. We will call you to schedule your appointment as soon as possible.

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