Texas Litter Control Surgical Release Form - All clients are required to sign this form prior to the

Texas Litter Control uses qualified staffing 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. Carefully read and understand the following before signing your name. If your pet is pregnant, in heat, or has any known reactions to medications, you need to inform the staff prior to surgery.

I, acting as owner or agent of the pet named above, hereby request and authorize Texas Litter Control, through whomever Veterinarians they may designate, to perform an operation for sexual sterilization of the animal named on the above portion of this form.

I, acting as owner or agent of the pet named above, hereby request and authorize Texas Litter Control, through whomever Veterinarians they may designate, to sedate the animal named above for diagnostics and/or treatment.

I understand that the operation and/ or sedation presents some hazards and that injury to or death of such an animal may conceivably result, for there is some risk in the procedure and the use of anesthetics and drugs in providing this service.

I either certify that my animal has been vaccinated within one year prior to this date or waive my right to protect my animal by having it vaccinated, or request recommended vaccinations at the time of surgery. I understand that it takes up to two weeks for vaccinations to protect my animal. I understand the inherent risks of failing to maintain current vaccinations and waive all claims arising out of or connected with the performance of this operation due to such failure.

I certify that my animal is in good health and has had no food since 9pm the evening prior to surgery. Puppies and kittens under 5 months of age are excluded from this requirement and can have been fed.

I understand that Texas Litter Control will perform a brief physical examination on my pet before surgery is performed. Feral and Community Cats receive a visual exam only. I also understand that my animal will not receive pre-operative blood work and waive my right to have this service performed prior to surgery and/ or sedation at a full-service Veterinarian or by Texas Litter Control.

I understand that some factors significantly increase surgical risk, including but not limited to, pregnancy, heat, and diseases such as Heartworm Disease, Feline Immunodeficiency Virus, and Feline Leukemia. Heartworms cause problems with the heart, lungs, blood clotting, and circulatory system. Pregnant and in-heat dogs who are heartworm positive are an even greater risk. I understand that Texas Litter Control will not run a heartworm test unless ordered and paid for by me. Dogs not on heartworm prevention have an extremely high chance of being heartworm positive due to the mosquito epidemic in the Houston and surrounding areas. Texas Litter Control has informed me of the risks in putting a dog under anesthesia without knowing whether the dog is heartworm positive or if my dog is heartworm positive.

I understand that if my animal is pregnant, the pregnancy will be terminated. I also understand that pregnancy significantly increases post-operative complications including death.

I understand that all feral and community cats are "ear tipped" at the time of surgery which means a small piece of the ear is removed (approximately 1/2 inch) as a visual identifier that the cat has had a rabies shot and has been sterilized.

I understand that if my animal has an open umbilical hernia, it will be repaired at time of surgery at an additional charge of $25.

I understand that if my animal has an un-descended testicle (“Cryptorchid”), it will be removed at time of surgery at an additional charge of $75. This charge includes oral pain medication to take home.

I understand that in some cases, the Veterinarian may recommend a prescription drug for a preexisting condition or to help prevent post surgical complications such as swelling and infection. If my pet should require a prescription, I will be responsible for paying for it. Texas Litter Control prescriptions are $10-$60 each depending upon the type medication and weight of the animal. If I refuse the recommended prescription(s), I assume responsibility for any and all post surgical complications.

I understand that at the Veterinarian’s discretion an off label medication may be used as indicated. I understand that I am responsible for monitoring the surgical site daily and not allowing my pet to lick or chew. I understand that I should keep an Elizabethan collar on my pet until the surgical site has healed (approximately 10 days.)

I understand that I am responsible to restrict my pet’s activity which includes using a leash when taking dogs outside.

I understand that if my pet was in heat at the time of surgery, it will take about 30 days for the hormones to leave the body. She may still attract males. The attempted breeding by a male can cause internal injury, hemorrhage and possible death.

I understand that if I don’t retrieve my pet at the agreed upon time that Texas Litter Control will exercise its right to either turn the animal over to the nearest humane organization or dispose of as deemed just and proper as allowed by the State of Texas. Owners will be assessed a $25 late fee if more than 30 minutes late for pick up. Owners of pets left after the agreed date shall be charged a boarding fee of no less than $50 per night. Pick up times are posted on the wall in the lobby and on the front door.

I hereby release Texas Litter Control, all Veterinarians, assistants, volunteers, directors, and employees from any and all claims arising out of or connected with the performance of this procedure or any adverse reactions from vaccinations. I agree that I have not and will not claim any right of compensation from them, or any of them, or file action by reason of such sterilization or attempted sterilization of such animal or any consequences related thereto. Owner/ agent hereby agrees to indemnify and hold Texas Litter Control harmless for any damages caused during the transportation of the animal, or for any damages caused by any unforeseeable events including fire, vandalism, burglary, extreme weather, natural disasters or acts of God.

I understand TLC does not share medical information about my pet without prior written consent. I waive this right to privacy if I provide information about services provided by TLC publicly via the internet or in any other public venue. My signature on this release form is consent to share medical information about my pet should I choose to publicly post about the standard of care or services provided by TLC.

Texas Litter Control is a 501c3 public charity and Texas Non Profit Corporation. Animals are sometimes photographed and posted to social media for promotional reasons. No customer names are posted. Photographs are property of Texas Litter Control. All rights reserved. If you do not want your pet photographed by Texas Litter Control please provide written notice to the staff. Your contact information will be released should your pet be found with and traced back to Texas Litter Control via the rabies tag or micro-chip.

If all or part of the services provided to your pet are being paid for by a third party, your medical records are provided to the paying party.

YOUR ANIMAL WILL RECEIVE A SMALL TATTOO ON HIS/HER UNDERSIDE TO SHOW THAT HE/SHE HAS BEEN STERILIZED.