Patient Form - Canine Neuter > 100lbs

"*" indicates required fields

MM slash DD slash YYYY
MM slash DD slash YYYY

I hereby authorize Drs. Fontanez of Portland Veterinary Hospital to perform the above stated procedure, as well as any other treatments that they deem necessary for the health and well-being of my pet while under their care. I undestand that I will be informed of any changes in the estimated fees due to unforeseen circumstances. The nature of the procedure has been explained to me and NO guarantee has been made as to the results or cure. I understand that there are always risks involved with any surgery or anesthetic protocol, but that precautions will be taken to minimize risks as much as possible. I understand that my pet will be released during office hours only, and that FULL PAYMENT IS REQUIRED UPON RELEASE OF MY PET.

I understand that should my pet injure itself in an attempt to escape, refuse food, suddenly become ill and die, or succumb to the effects of natural disasters (hurricanes, lightening, tornadoes), I can't hold Portland Veterinary Hospital liable in the absence of gross negligence as provided by state law.

Canine Neuter > 101 lbs

Please select all that apply*
Prices noted are estimated costs subject to change
MM slash DD slash YYYY