I have read and agree to all of the following:

1. I certify that I am 18+ years old.

2. I am the owner or agent of the owner of the animal described above and I have the authority to execute this consent. I have fully disclosed all known pertinent medical history of the animal named above to the best of my ability. To my knowledge, the animal is in good health and has had no food or treats since 12:00 midnight last night unless otherwise instructed by the Clinic staff.

3. I understand that my pet will be given a very limited examination prior to the administration of anesthesia, and that the West Valley Humane Society recommends that a full physical exam and appropriate blood work be performed by my veterinarian prior to outpatient surgery.

4. I also understand that my pet should be current on all vaccines, dewormed, and free of fleas/ticks/ear mites at the time of surgery. I acknowledge that the healthier my pet is, the lower the risk of developing complications associated with anesthesia, surgery, and outpatient hospitalization.

5. If my pet is to be vaccinated, I hereby give permission for my pet to be vaccinated at West Valley Humane Society by either the veterinarian on duty or the veterinary technician on duty.

6. I understand that if I do not schedule a vaccination appointment within 3 weeks of form submission, I will be required to fill out a vaccination form.

7. I am aware that WVHS does not vaccinate sick, diseased, or pregnant animals. I have disclosed such information. I have also made WVHS aware of any previous vaccine reactions my pet may have had, including any allergies. I acknowledge that such vaccinations do not constitute complete healthcare.

8. I understand that vaccinations may cause unexpected reactions in pets, including death. I understand that there will be no guarantees as to the results, effectiveness, or accuracy of any vaccination.

9. I understand that if my pet at any time becomes too aggressive for WVHS staff to safely handle, I will be asked to restrain my animal with a muzzle. I release WVHS of all liability and understand that I may be assessed additional fees up to $25.

10. I agree to accept all risk of vaccinations and personally accept both legal and financial responsibility for all charges incurred. I understand that WVHS will not assist with emergency care, and I am financially responsible for any other veterinary visits.

11. I understand that a chip will be implanted under the skin of my pet and will be scanned to verify effectiveness at the time of the visit. I also understand that chips may migrate, break, or otherwise deactivate over time, and WVHS offers no guarantee as to the results, effectiveness, or accuracy of the microchipping.

12. I understand that the microchip should be scanned each time I visit my veterinarian. I understand that in rare circumstances, the microchip may travel or sustain damage and no longer be readable. If this happens, I understand that I would have to pay to have an additional microchip implanted.

13. I understand that the attending veterinarian may decline my pet for surgery for various reasons.

14. I hereby consent to and authorize the use of appropriate anesthetics, other necessary medications, and the performance of sterilization surgery, commonly known as spay or neuter surgery, tattoo as permanent proof of sterilization.

15. I understand that during the performance of the foregoing procedure or operation, unforeseen conditions may be revealed that necessitate an extension of the foregoing procedure or operation or different procedures or operations than those set forth above. Therefore, I hereby consent to and authorize the performance of such procedures or operations as are necessary and desirable in the exercise of the veterinarian's professional judgment.

16. I acknowledge that no guarantee of results has been given or implied by West Valley Humane Society or its staff members.

17. I have received an estimate of the probable costs of the procedure or operation or have declined to receive such an estimate. I understand that I am fully responsible for all costs incurred.

18. I also acknowledge that complications may develop during surgery or post-surgically and that I assume responsibility for all post-operative care and veterinary expenses incurred as a result of such surgery. I understand that should my pet chew or lick the incision, I am responsible for surgical repair costs.

19. I understand that all cats must arrive in separate carriers and dogs must arrive with a well-fitted collar/harness and a leash. I also understand that my animal must not have eaten after midnight the day of surgery.

20. I agree to pick up my pet at the time specified, and I understand that if I fail to do so, I will be liable for overnight boarding fees.

21. I agree to indemnify and hold harmless the West Valley Humane Society, the attending veterinarian, and any of the officers or employees of said entity from any and all claims, damages, and causes of action that may arise from the procedures or operations to be rendered and from other medical care arising therefrom.

22. I have been advised as to the nature of the procedure or operation and the risks involved, including death. I have read and understand the Risks and Complications Fact Sheet.

23. West Valley Humane Society will provide limited vet services directly related to the incision and/or surgical complications with limited diagnostic ability. I may be referred to my own vet for additional care at my own expense.

24. This service is to be used for privately owned pets and is not to be used for: the sale of pets, low-cost services for another rescue, or any other organization unless given explicit permission by the shelter.

25. I understand the vaccine clinic is an opportunity for WVHS to provide reduced-cost vaccines. It is not a setting for comprehensive exams, consultations, diagnosis, treatment, medical concerns, or other behavioral problems. I understand these need to be addressed by my family veterinarian.

26. My signature on the Anesthesia and Surgical Consent Form indicates that I have read, discussed as necessary, and understand the possible risks and complications that may arise.

27. I understand that if a vaccine appointment is missed, the vaccines can be resumed based on the vaccine that is recommended for the age of the animal at that time. Any vaccines that are missed will be forfeited, and no refunds will be issued.