Cat Clinic Sign Up Cat Clinic Sign Up Phone Number * Address * Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal *PLEASE NOTE* We are closed the month of September. October dates will be posted on October 2nd. Please do not sign up until you are able to choose a date. Thank you. Name * Email Address * Cat's Color * Cat's Coat Length Short Hair Medium Hair Long Hair Cat's Name * Cat's Gender * Male Female Cat's Age * Do you have any concerns about the health of your cat? If so, please make us aware. Authorization Agreement * I hereby authorize Dr. Dowty to examine, prescribe for, or treat the pet described above. I assume responsibility for all charges incurred. I will use all reasonable precautions against injury, escape, or death of my pet, but you will not be held liable or responsible in any manner and it is thoroughly understood that I assume all risks. My cat is at least 12 weeks old and 3 pounds. I have ready the welcome page. **Note: We do not offer vaccinations, flea treatment, or nail trims unless your cat is here for surgery. By signing or typing your FULL name in the signature field below you agree to and authorize the above agreements. * Clear Check the package you would like for your cat: Male Neuter Package (Neuter, Rabies, FVRCP, Wormer, and Flea Treatment) - $65.00 Female Spay Package (Spay, Rabies, FVRCP, Wormer, and Flea Treatment) - $85.00 Female Spay Pregnant Package (Spay, Rabies, FVRCP, Wormer, and Flea Treatment) - $105.00 Total Check the a la carte services that you would like for your cat: Microchip for Cats - $20.00 Male Neuter (Must bring current rabies certificate) - $49.00 Female Spay (Must bring current rabies certificate) - $69.00 Feline Leukemia/AIDS Test - $25.00 Female Spay Pregnant (Must bring current rabies certificate) - $89.00 1 year Rabies Vaccination (REQUIRED - or Certificate must be provided) - $8.00 FVRCP - (Recommended) Feline Rhinotracheitis, Calici-Panleukopenia, Chlamydia - $10.00 Flea Treatment - $5.00 Ear Mites - Cleaning and Tresiderm - $25.00 Wormer - $3.00 Ear Tip (feral cats only) - $3.00 Total Pre and Post Surgery Instructions Agreement * I will bring my cat indoors the night before surgery, provide a litter box and remove all food before midnight. I will have water available throughout the night. I understand that after anesthesia, my cat won’t be able to regulate his/her body temperature. I will provide a place in my home, with a comfortable temperature and a litter box for at least 3 nights. Check the complimentary services that you would like for your cat: Nail Trim - Indoor Cats Only If you are human, leave this field blank.