Surgical Authorization Form - General


GOODCAT VETERINARY HOSPITAL

1215 EYE ST., BAKERSFIELD, CA 93301  (661) 214-3002

PET PARENT (SIGNER) INFORMATION

Pet Parent (Signer) First Name  

Pet Parent (Signer) Last Name

Signer Email Address  

Signer Phone Number  

CAT (SURGICAL PATIENT) INFORMATION 

Name of Surgical Patient  

Gender of Surgical Patient  

Age of Surgical Patient  

Goodcat Veterinary Hospital used qualified staff and approved materials for all procedures performed. It is important for you to understand that the risk of injury or death, although extremely low, is always present, just as it is for humans who undergo surgery. I, being lawfully authorized to make decisions on behalf of the cat named/described above (the “Cat”). hereby requests and authorize Goodcat Veterinary Hospital, through whomever veterinarians they may designate, to prescribe for, treat and/or administer vaccinations and/or perform an operation for sexual sterilization of the Cat.

  • I understand that the operation I have elected presents some hazards and that injury to, post-operative infection in, or death of the Cat may conceivably result because there is some inherent risk in the procedure an in the use of anesthetics and drugs provided for the procedure, as well as in any vaccines used. I understand that general anesthesia will be used to the Cat for surgery. I understand and accept these risks to the Cat.

  • I either certify that my Cat has been vaccinated within 1 year prior to this date, or waive my right to protect my Cat by having
    it vaccinated, or request recommended vaccinations at the time of surgery. I understand that it takes up to two (2) weeks for vaccinations to protect the Cat. I understand the inherent risks of failing to maintain current vaccinations, and I waive all claims arising out of, or connected with, the performance of this operation due to such failure. I understand that if the Cat develops kennel cough or other upper respiratory infections after surgery, I am responsible for treatment at my own cost.

  • I understand Goodcat Veterinary Hospital has the right to refuse any service and/or procedure to the Cat for any reason, including but not limited to, a situation where surgery is deemed a heath risk. Such refusal is at the sole discretion of the attending veterinarian.

  • I certify that my Cat is in good health and has had no food or water since 12:00 midnight the evening prior to surgery.

  • I understand that a brief pre-surgery exam will be performed on the Cat, except in the case of feral/community cats arriving in cat traps. I understand that the Cat will not receive pre-operative blood work at Goodcat Veterinary Hospital unless I specifically request to have it done prior to surgery.

  • I understand that some factors significantly increase surgical risk, including but not limited to, pregnancy, heat, and diseases such as feline immunodeficiency virus (FIV), feline leukemia virus (FeLV), and heartworms.

  • I understand that if the Cat is pregnant, the pregnancy may be terminated at surgery. Specific to Spay/Neuter Add-on surgery.

  • If an unforeseen event/emergency situation occurs or a medical condition is discovered that requires urgent immediate treatment, I consent that the attending veterinarian may perform such treatment, or transport the Cat to another veterinarian for the provision of such treatment, without seeking additional authorization or consent from me.

  • I understand that if I do not retrieve my Cat(s) at the agreed upon time, Goodcat Veterinary Hospital will exercise its right to either turn the animal over to Bakersfield City Animal Control or transfer the Cat as deemed just and proper, and as allowed by the State of California under CC1834.5. Owners of pets left after the agreed date shall be charged a boarding fee of no less than $25 per night. At the cessation of the workweek, all remaining animals that have not been picked up will be turned over to Animal Control for staff safety and liability issues.

  • I understand and agree that Goodcat Veterinary Hospital shall not be liable or held responsible by me in any matter whatsoever, or in connection with, the procedure(s) to be performed on the Cat and/or any vaccinations to be given to the Cat, and I hereby hold Released Parties harmless from and against any and all liability and damages that may arise. I will take full responsibility, financial and otherwise, if the Cat becomes ill, unless the illness is a post-operative complication caused directly by surgery. I hereby agree to indemnify and hold the Released Parties harmless for any damages caused during the transportation of the Cat. The Released Parties shall not be held liable for any damages caused by any unforeseeable events including fire, vandalism, burglary, extreme weather, natural disasters, or acts of God.

  • I HEREBY WARRANT THAT I (A) AM AT LEAST EIGHTEEN (18) YEARS OF AGE, (B) HAVE READ THIS AGREEMENT CAREFULLY PRIOR TO ITS EXECUTION, (C) FULLY UNDERSTAND THE CONTENTS OF THIS AGREEMENT, (D) REALIZE THIS AGREEMENT IS AN ENFORCEABLE LEGAL DOCUMENT BETWEEN MYSELF AND GOODCAT VETERINARY HOSPITAL, AND (E) VOLUNTARILY SIGN THIS AGREEMENT OF MY OWN FREE WILL.

All surgeries Include Pre-surgical Veterinary Exam, and Anesthesia monitoring.

 

*Application of Surgical add-ons subject to patient age, physical condition, medical history and availability. All Surgical add-ons must be approved by attending veterinarian prior to given service/treatment. Request of/for Surgical Add-ons is not a guarantee of receiving the mentioned above service/treatment(s).

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Document name: Surgical Authorization Form - General
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Timestamp Audit
July 29, 2020 3:22 pm PDTSurgical Authorization Form - General Uploaded by Daniel Mariano - medical@meowco.org IP 99.95.140.69