EmailMeForm
Canine Spay/Neuter Registration & Liability
Due to COVID-19, we are only accepting applicants who reside in La Plata, Archuleta and Montezuma counties until further notice.
Please complete form in its entirety if you wish to make an appointment to have your pet spayed or neutered by La Plata County Humane Society. Payment is due in full when appointment is scheduled.
Today's Date:
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Owner Information:
Name:
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First
Last
Primary Phone:
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Physical Address:
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Street Address
City
State / Province / Region
Postal / Zip Code
Email:
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Person to contact if you cannot be reached:
Name
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Phone Number:
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SERVICE TO BE PROVIDED:
Please Select Service:
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Canine Neuter (male) $120.00
Canine Spay (female) $150.00
Additional Costs:
In Heat $20.00
Pregnant $20.00
Umbilical Hernia $15.00
Over 70lbs. $20.00
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I understand that if any of the above is noted during surgery, I will be charged the additional cost(s).
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I understand that all dogs will leave in an e-collar (cone), which is provided with the service.
Cryptorchids (the absence of at least 1 testical from scrotum) are not accepted.
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Cryptorchids (the absence of at least 1 testical from scrotum). I understand that if the dog is male, I must contact LPCHS before my appointment to confirm that there is no cryptorchid, and that lack of confirmation may result in refusal of service.
Vaccination Requests:
Please select all vaccinations or services you would like your pet to receive.
DA2PPV (Canine Booster-Distemper, Adenovirus Type 2, Para Influenza and Parvovirus) $25.00
Bordetella (Kennel Cough) $25.00
Rabies Vaccine $25.00
Heartworm Test $45.00
De-wormer for Tapeworms $20.00
Microchip $45.00
Nail Trim $10.00
E-Collar (Included Upon Request)
Has you pet ever had a bad reaction to a vaccine?
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Yes
No
Is your pet on any medication at this time?
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Yes
No
If yes, what?
LIABILITY WAIVER:
Owners Name:
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Primary Phone:
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Physical Address:
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Street Address
City
State / Province / Region
Postal / Zip Code
Animal Name:
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Gender
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Male
Female
Age:
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Months or Years
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Months
Years
Weight:
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Primary Breed:
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Primary Color
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Please select
Black
Brindle
Brown
Calico
Golden
Gray, Blue or Silver
Merle
Red
Tan
Tricolor
Yellow
White
Secondary Color
Please select
Black
Brindle
Brown
Calico
Golden
Gray, Blue or Silver
Merle
Red
Tan
Tricolor
Yellow
White
LPCHS uses qualified staff and approved materials for all procedures performed. It is important for you to understand that the risk of injury or death is always present. Carefully read and understand the following before signing your name.
Acting as guardian of the pet named above, I hereby authorize authorize LPCHS, through veterinarians designated by LPCHS, to perform an operation for sexual sterilization.
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I certify that my pet is in good health and has had no food since 12:00 a.m. on the evening prior to surgery.
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I understand that LPCHS has the right to refuse service to any animal for who surgery is deemed a health risk.
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I understand if my animal is deemed to be older than stated above, LPCHS has the right to refuse surgery.
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I understand that if I do not retrieve my pet by 5pm the same day that surgery is performed, I will be charged a $30.00/per night boarding fee.
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I understand that the operation presents some hazards and that injury or death may be a result, for there is some risk in the procedure and the use of anesthetics and drugs in providing this service.
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I understand that my animal may be exposed to a contagious disease during the clinic and if my animal is not fully vaccinated and contracts any illness I am responsible for seeking out and paying for veterinary care.
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I understand that some factors significantly increase surgical risk, including but not limited to: pregnancy, heat, advanced age, and disease such as FIV, FeLV and heartworms.
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I understand that serious complications can occur as a result of this surgery, including, but not limited to: bleeding, nerve damage, bowel or urinary problems, blood clots and heart attack, allergic or other reactions to drugs or anesthetics.
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I understand that individual pets may respond differently to anesthesia and because of the stress of a surgical procedure, unexpected reactions may occur under anesthesia. Some complications are unpredictable and in rare cases, cause death.
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I understand that during these procedures, unforeseen conditions may occur, require a change of the procedures listed above & I give my consent for the performance of such procedures as deemed necessary in the judgment of the veterinarians.
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I understand that my animal will not recieve pre-operative blood work and waive my right to have this service performed prior to surgery. If you would like to have pre-operative blood work, there will be a $60.00 fee.
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I understand that if I don't retrieve my pet at the agreed upon time, LPCHS will exercise the right to adopt the pet out after five days of no contact, authorized by Colorado Law.
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I hereby release and forever discharge LPCHS, its employees, agents, representatives, Officers & Directors from any and all actions, claims or costs on account of or in any way arising from the surgical services authorized by this Release.
Payment is due in full when appointment is scheduled. Appointment(s) will not be scheduled if payment has not received.
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I understand payment is due in full when my pet's appointment is scheduled.
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I understand I understand that I am required to provide 24 hours notice when canceling and re-scheduling appointments to avoid being charged. Same day and "no show" appointments are not eligible for a refund.
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I understand a team member will call me to schedule an appointment and process my payment.
Signature
If using a computer or labtop, use mouse to add signature. If using tablet, sign with finger.
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Upload valid drivers license or government ID
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Upload proof of residence if not shown on photo ID.
