Pet Drop-Off Form

Must fill out a form for each Pet.

With whom will we be contacting to for medical and financial decisions? For all anesthetic procedures, an authorized individual must be reachable by phone.

No P.O. Box Allowed; CAN NOT Take Pet In
Has your pet ever had or currently have any health problems?
Has your pet ever had any pain or adverse/allergic reaction to any vaccines, medications, procedures, etc.?

Is your pet current with all vaccinations that are required for surgery, boarding, or other type of drop-off?

Vaccine Requirements for Dogs:

  • DAPP (Distemper, Adenovirus, Parvovirus, Parainfluenza)
  • Leptospirosis 4-Serovar
  • Bordetella
  • Bivalent Flu (H3N8 and H3N2)
  • Rabies

Vaccine Requirements for Cats:

  • FVRCP
  • Feline Leukemia (Feline Viral Rhinotracheitis, Calicivirus, Panleukopenia)
  • Rabies

If YES, please provide records.

If NO, we will vaccinate your pet today. We are not responsible for pets getting sick while in our facility if the pet is not fully vaccinated.

Current on vaccinations as detailed above?
One file only.
100 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.
Is your pet current on heartworm prevention (required for all dogs being dropped off)
Is your pet current on flea and/or tick prevention?

Anesthetic and Surgery Consent Form for your Pet

The safety, health, and well-being of your pet are our primary concerns here at Katy Pet Wellness Solutions. Before your pet has surgery today, he or she will be examined for any problems that could interfere with anesthesia and will be monitored after surgery to help ensure that your pet has a safe and comfortable recovery. We are happy to report that our patients do very well, and we expect all to go smoothly.

Please check each of the following statements. If you decline, we CAN NOT take your pet in.

Personal Belongings
Please check all of the following to acknowledge:
If your pet is not up to date, your pet will be vaccinated upon arrival to reduce the risk of contracting illnesses during their stay. Note that full vaccine protection takes several days after administration.
A heartworm test will be done on dogs that are not up to date and/or have no verifiable records showing consistent purchase of heartworm prevention. A $30 charge will be added to your balance.
If a patient has tested positive for heartworm disease and you wish to proceed with surgery, an intravenous catheter will be placed and your pet will be given a dexamethasone injection to prevent cardiovascular shock during surgery. An extra charge of $115 will be added to the balance.
A flea or tick control product will be administered to pets with live fleas or ticks and a charge will be added to your balance which will be $18-$54 depending on the product administered.
If your female pet presented for spay surgery and is pregnant or in heat, there will be an additional charge to your balance. This is not always evident at the time of the preoperative exam and often is discovered after the procedure begins. Fees are as follows: Pregnant Fee (Dogs & Cats): $99 Dog in Heat: $99 Cat in Heat: $65
If your male pet presented for neuter surgery has cryptorchidism, there will be an additional charge to your balance. This is not always evident at the time of the preoperative exam and often is discovered after the procedure begins. Fees are as follows: Cryptorchid, Inguinal Fee: $99 Cryptorchid, Abdominal Fee: $190
In the case that problems are detected following such blood analysis, it may be necessary to postpone or change the planned procedure until the medical problem is resolved.
Hair clippers will be used to remove hair at the incision or treatment site. Also, clippers may be used to draw blood or place an intravenous catheter on the legs and/or neck (jugular) areas.
The construction of the suture material affects the reactions that take place in the tissues. Suture reactions can prolong healing time, and increase treatment costs. There is no way to predict which patient will have a suture reaction unless they have such a history. I understand that Katy Pet Wellness Solutions is not liable for any suture reactions my pet can have and treatment for suture reaction is my responsibility. Similarly, I understand that I am responsible for repair or further treatment of incision and treatment sites that may be compromised by my pet licking or chewing the treatment area.
Extractions: Quotes for extractions are given during dental cleaning procedure by a phone call. Make sure your phone is available to approve any extractions. Please remember, that your pet will be under general anesthesia during the time of dental cleaning procedure. If we do not hear from you, we will continue to finish dental cleaning without extracting any tooth, for the safety and care of your pet. Extractions may need to be scheduled at a later date.
Pick up time will be as follows, unless otherwise specified. For Spay, Neuter, or other Surgeries: Pick up will be same day between 4:00pm and 4:30pm. For Dental Cleaning/Surgeries: Pick-up will be the same day between 4:00 pm and 4:30pm. For Cat De-Claw Surgeries: Pick-up will be between 4:00 pm and 4:30 pm Monday through Friday and 10:00 am to 12:00 pm on Saturdays two days after the procedure.

Check the services to be performed today

Drop Off
Please describe quantity and location(s) in the "Other" box below.
Vaccinations
If your pet is not up to date according to the requirements listed above, we will vaccinate your pet today. We are not responsible for pets getting sick while in our facility if the pet is not full vaccinated.
Test
Treatments/Prevention

I hereby authorize and direct Katy Pet Wellness Solutions to perform the procedure(s) noted above and to administer anesthetics or other drugs as deemed advisable for my pet. I understand the nature of the procedures and the relative risks involved; I authorize Katy Pet Wellness Solutions to provide any appropriate care should an unexpected complication arise.

Authorization to Provide Care

1. I, the owner/authorized agent of the pet listed above, authorize the veterinarians or agents of Katy Pet Wellness Solutions to perform the services described above and all other procedures, diagnostic, treatment and/or administration of extra label medications within accepted veterinary guidelines as deemed advisable and/or necessary for my pet.

2. I authorize Katy Pet Wellness Solutions to obtain all medical records regarding my pet where my pet has previously been examined or treated at another veterinary practice or hospital and to release all medical records regarding my pet to any other hospital.

3. Although Katy Pet Wellness Solutions will take every reasonable action to ensure the success of my pet’s procedure(s), I understand that there is a risk of complication with every procedure, including the possibility of death as a severe complication of surgery, anesthesia, or other procedure(s). I also understand that there is no guarantee as to the results of any procedures, diagnostics, vaccinations, or treatments. I understand that I may ask any questions that I have regarding any procedure, diagnostic, vaccination, or treatment recommended by the Katy Pet Wellness Solutions veterinarians.

4. The nature and risk(s) of any procedure(s), including surgery and anesthesia if applicable, have been or will be explained to me or I will see that they are explained to me, and any questions I may have are answered, before I will leave my pet or allow treatment. I understand that Katy Pet Wellness Solutions is not liable for any of these actions. I understand that Katy Pet Wellness Solutions staff may not be present in the hospital overnight and that portions of my visit may be recorded for educational purposes. I understand that there is no guarantee nor can be made as to the results or cure of any therapy.

5. I understand that the veterinarians of Katy Pet Wellness Solutions recommend treatments, medications, surgery, and other preventative care based on lifestyle for my pet, but that other veterinarians may have different opinions about treatments, medications, surgery, and other preventive care. If a conflict arises, the veterinarians of Katy Pet Wellness Solutions will defer to board-certified veterinary specialists.

6. If I neglect to pick up my pet within 3 days of the above date, Katy Pet Wellness Solutions is to assume that the pet has been abandoned and Katy Pet Wellness Solutions is hereby authorized to make other arrangements for the pet as Katy Pet Wellness Solutions may deem best. In the event of an emergency, or as determined by the veterinarian, it may be necessary for my pet to be taken to an emergency hospital or outside the clinic. I authorized Katy Pet Wellness Solutions to walk or transport my pet outside of the hospital and provide treatment by the emergency hospital to stabilize my pet. I understand that Katy Pet Wellness Solutions will take reasonable precautions to ensure the safety of my pet while in their care.

7. I agree to pay, in full, for services rendered. I understand that payment is due at the time services are rendered. If for any reason payment is not made at the time services are rendered, I understand that my account wil be referred to a collection agency. In the event that my account is referred to a collection agency, I agree that Katy Pet Wellness Solutions may add an amount to my outstanding account balance to reimburse Katy Pet Wellness Solutions for the reasonable collection charge (but not including attorney’s fee) imposed by the collection agency.

Sign above