Saving Strayz Low-Cost Cat Clinic
Important Clinic Registration Information: Please ensure all required fields are completed before submitting your form to secure and lock in your clinic dates.⚠️ No Refund Policy:There are no refunds once your clinic date is reserved. We will move you to a different date but can’t give refunds. If you miss your clinic date, you will need to reschedule and pay again. Each missed appointment takes away a spot from another person and affects our ability to pay the veterinarian, as we guarantee those spaces will be filled.
What Clinic date would you like:, January 12th, January 26th
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Are we EAR tipping? (ONLY APPLIES TO CATS)
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Name
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First Name
Last Name
Email
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example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Pe enter a valid phone number.
Animals Name
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Weight (approx): ___________ lbs
Cat or Dog
Breed
Male or Female
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Age
DROP OFF IS THE EVENING BEFORE THE SURGERY DATE. SO 11/10 Drop off would be 11/09
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Weston 7:00pm Kwick Trip Barican st Weston Parked behind Brews Brothers Facing Holiday Inn
Your animal might need medication(S) Do we have permission to send it and bill you? Also if your animal has fleas there will be a $10 Per Animal fee * Hernias will be a $35 charge do you agree?
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Does your cats have coughing,sneezingAny health concerns we should be aware of? Any medication recently or currently on
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Barn Cats must have ear-tipped for price
BARN CAT PRICE INCLUDES: Ear Tip (Required) Full Veterinary Exam 2 Days of Pain Medication Ear Cleaning Nail Trim Distemper Vaccination
$
80.00
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Just a cat fix
FULL VET EXAM NAILS, EARS DONE TWO DAY PAIN MEDICATION
$
105.00
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The Works- Cats
FULL VET EXAM NAILS, EARS DONE RABIES, DISTEMPER VACCINATIONS TWO DAY PAIN MEDICATION
$
135.00
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Keep Me Safe
FULL VET EXAM PACKAGE Includes: ✅ Comprehensive Veterinary Exam ✅ Rabies & Distemper Vaccinations ✅ 2 Days of Pain Medication ✅ Nail Trim & Ear Cleaning ✅ Microchip (Included) All in one visit — professional care for your pet's health and safety!
$
165.00
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Rabies Vaccination
Cat or Dogs
$
20.00
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Microchip
Cat or Dogs
$
30.00
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Frontline Flea Preventive Cat or Dog
1-Month supply
$
25.00
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Distemper Shot
$
20.00
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Fiv/Felv Testing
Tests for FIV, FELV Instant results same day.
$
40.00
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Basic Dog
*Spay or Neuter * Ears Cleaned * Nails Trimmed* Two Day pain medication * Rabies Vaccine* Head to toe Vet exam
$
325.00
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Dog- Keep me Safe
Spay or neuter* Ears cleaned* Nails trimmed* Two days pain meds* Microchip* Rabies Vaccine* Head to toe Vet exam
$
Free
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Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
I am over the age of 18 and the lawful owner (or the owner’s authorized representative) of the animal described on the front of this form. I amdelivering this animal to Precision Veterinary for certain medical treatment as follows:SPAY/NEUTER SURGERY AND/OR VACCINATIONSI agree to be bound by the following terms and conditions:1. Authorization for Procedure. To the best of my knowledge, my animal is in good health and is able to undergo the medical procedure.I hereby authorize Saving Strayz transport and Precision Veternary to receive, treat, prescribe, transport, care for and house my animal and to perform such anesthetic,medical, surgical and therapeutic procedures as indicated above.2. Acknowledgement of Risks. I understand that, as with any instance in which my animal is outside the home, my animal may beexposed to other animals that have not been appropriately vaccinated or that have been exposed to contagions and illnesses. I alsounderstand that local and/or general anesthesia will be administered to my animal and a medical procedure will be performed on myanimal; this involves uncertainty and risks to my animal. I understand and acknowledge this information and I assume all risks associatedwith the anesthesia and medical procedure, including any adverse effects, illness or death of my animal. If my animal is receiving aspay/neuter procedure, I understand that the animal may receive a small tattoo on his/her underside to show that he/she has beensterilized. I understand that a brief pre-surgical exam (or visual exam of fractious animals) will be performed, and I also understand thatthe attending veterinarian performing the medical procedure has the right to decline to perform any procedure on any animal for anyreason. I understand the animal will not receive pre-op bloodwork or IV catheterization/fluids. If I choose for the animal to have suchbloodwork done, I understand it must be performed at a full-service veterinary clinic. If, in the course of treatment or during the procedure,the animal is found to be pregnant, the pregnancy will automatically be terminated. If any other condition is discovered that requires medicalattention or an additional procedure(s), we will call the owner or authorized representative at the phone listed on this form. If we are unableto reach the owner or authorized representative in a timely manner, the attending veterinarian may in his/her absolute and sole discretion,perform such procedure(s) without seeking additional authorization or consent from the owner or authorized representative. I consent toany such additional procedure(s) and agree to take full responsibility, financial and otherwise, if my animal becomes ill.3. Post-Procedure. I agree to contact my own veterinarian with any questions that arise following the medical procedure about my animal’shealth related or unrelated to the medical procedure. I agree to follow the Post-Surgical Home Care Instructions or any other instructionsreceived by me from Precision Veterinary. If I suspect that my animal has a postoperative complication caused directly by the procedure,it is my responsibility to seek veterinary care in an appropriate and timely fashion, and will bear financial responsibility for any expensesincurred.4. Animal Pickup. I understand that all animals shall be picked up from the clinic by me, or by someone authorized on my behalf, at thetime designated by the clinic staff, on the same day as procedures or vaccinations are performed, unless otherwise arranged in advance.If my animal is not picked up at the designated time on that day, I understand that I am incurring an unplanned boarding penalty of $25 pernight for cats and $30 per night for dogs.Should my animal remain unclaimed for 10 or more days, it may be considered abandoned by me and sole-custody will be relinquished toa local rescue or sheltering agency per Wisconsin State Law. At this time Precision Veterinary will cease to hold legal responsibility for thecare and wellbeing of your animal and all further decisions regarding its disposition will be made at the sole discretion of the aforementionedagency. If the animal is returned to me, I agree to pay any and all fees and related costs, including, without limitation, any costs to medicateor otherwise provide for the animal.5. General Release and Waiver. I understand that Precision Veterinary will rely on my representations made in this agreement. I knowthat this is a legal document and I promise that to the best of my knowledge everything that I have said is true. No one has forced me tosign this document. I am willing to sign this waiver and release agreement because Precision Veterinary will provide the spay or neuter,vaccination, and/or other medical services as I requested. I am consenting to the medical procedures being performed on my animal andall related activities of any kind and acknowledge that I understand that all risk, whether known or unknown, is expressly assumed by meand all claims, whether known or unknown, are expressly waived in advance. On behalf of myself, my heirs, personal representatives andassignees, I hereby release, discharge, indemnify and hold harmless, Precision Veterinary and its directors, officers, employees, volunteersand agents from any claims, causes of action and demands of any nature, whether known or unknown, arising out of or in connection withthe medical procedure performed on the animals and all related activities of any kind including without limitation other treatment and caregiven to the animals or the housing of the animals. By signing this Waiver and Release Agreement, I am consenting to the medical procedures being performed on my animal and all related activities of any kind and acknowledge that I understand that all risk, whetherknown or unknown, is expressly assumed by me and all claims, whether known or unknown, are expressly waived in advance.I also understand and agree to permit Precision Veterinary to use my name and pictures of me and/or my animal for publicity or promotionalpurposes without liability or obligation to me.CONSENTBy signing, I acknowledge that I have read, understood and agree to all the terms listed above and on the reserve side of his form, and confirm that allthe information given on this form is correct.Owner Signature Date
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