Registration No.
BIYAYA: Spay and Neuter Surgery Consent Form
Owner’s Name: Date of surgery:
Address:
Cellphone number: Email add:
Name of Pet Age of Dog or Male or Color of Pet Indoor/ Breed
Pet Cat Female Outdoor/Both
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Please answer the following questions below: YES NO
1. Is your pet physically healthy? [ ] [ ]
2. Is your pet diagnosed with a disease or condition prior the surgery? [ ] [ ]
If yes, state here:
3. Is your pet currently taking any medication/s? [ ] [ ]
If yes, state here:
4. My pet’s vaccines are updated annually
▪ Anti-Rabies Vaccine [ ] [ ]
▪ 5 in 1 vaccine (DOGS ONLY) [ ] [ ]
▪ 4 in 1 vaccine (CATS ONLY) [ ] [ ]
5. My pet’s deworming is up to date [ ] [ ]
6. Is your pet eating and drinking regularly? [ ] [ ]
7. Has your pet experienced any of the following prior the surgery:
▪ Vomiting [ ] [ ]
▪ Diarrhea [ ] [ ]
▪ Loss of Appetite [ ] [ ]
▪ Sneezing/ Nasal discharge [ ] [ ]
▪ Problems in urinating [ ] [ ]
▪ Liver problem [ ] [ ]
▪ Kidney problem [ ] [ ]
FOR FEMALE DOGS AND CATS ONLY
8. When was the last heat cycle of your pet?
Please state here: [ ] I do not know
9. Is your pet pregnant? [ ] [ ]
10. Does your pet have a history of pregnancy? [ ] [ ]
If yes, when ?_______________________
[ ]Cesarian [ ]Normal [ ]I do not know
FOR CATS ONLY
(universal marking that your pet is already neutered)
EAR NOTCH [ ] EAR TATTOO [ ]
NOTE:
Neutering is a surgical procedure where in the uterus and ovaries are removed from the female pet and the testicles are
removed for the male pet to prevent them from unwanted reproduction.
✓ Your pet must be fasted 6-8 hours prior the surgery to prevent them from vomiting during the procedure.
✓ It is highly recommended that pets must be placed in a secure cage to prevent them from escaping.
✓ Blood test prior the surgery is required for us to assess if the animal is apparently healthy
✓ There is still possibility that after seven (7) days the male pets may still get female pets pregnant due to their reserved sperm.
Registration No.
Please carefully read and ensure you understand the following:
▪ The owner of the pet hereby authorized Biyaya Animal Care through whomever Veterinarian they may designate to perform the
sexual sterilization of the animal named on this form.
▪ I understand that my pet will undergo anesthesia and other medications needed to perform the surgery. In line with this, the
operation presents some hazards, and that injury to and post-operative infection in, or death of, the animal may conceivably result.
I understand and accept these risks to the animal. I withhold BIYAYA from any liabilities without proper medical examination and
communication with our veterinary team.
▪ Blood Test prior surgery: I understand the animal will have to receive pre-operative bloodwork prior the surgery to assess if they are
PHYSICALLY FIT. For pets aging two (2) years below, CBC (complete blood count) is required. For pets aging three (3) years and
above, CBC and blood chemistry is required.
▪ Outreach events only: I understand the animal will not receive pre-operative bloodwork, If I choose for the animal to have such
bloodwork , I understand it must be performed at a full-time veterinary clinic.
▪ I am allowing my pet to be neutered without vaccination, I am aware of the risks and complications involved. 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 procedure due to such failure.
▪ FEMALE DOGS and CATS: I understand that if my pet is PREGNANT, I consent BIYAYA to terminate the pregnancy. : I understand that
if my pet has PYOMETRA (Infection of uterus), I consent BIYAYA to continue with the procedure.
▪ MALE DOGS and CATS: I understand that if my pet has UNDESCENDED TESTICLES, I consent BIYAYA to continue with the procedure.
▪ Social media policies: No posting of surgical photos without the consent of the organization, any misleading comments, claims,
rumors and statement without going through our admin team communications are subject to legal actions.
▪ Open Wound beyond 5 days is not free of charge for repair.
CARE & GUIDELINES AFTER SURGERY
▪ Your pets will undergo anesthesia, let it rest to recover. Allow 3-4 hours to pass before giving moderate food and water.
▪ Do not let your pet jump, run and play for one (1) week to prevent dehiscence of wound.
▪ Do not bathe for one (1) week. Use E-collar to prevent licking, biting and scratching of wound.
▪ Your cat will have an ear notch/tattoo as a universal marking that it is already neutered.
▪ Be sure to follow and give the prescribed medication to avoid any infection.
NOTE:
Your pet may display inactivity for two (2) days after the operation. If there’s unusual bleeding, wound infection,
lethargy, loss of appetite or vomiting, please IMMEDIATELY CONTACT OR BRING YOUR PET TO US AT BIYAYA ANIMAL CARE.
Contact Number: 0917-543-3444
CONSENT By signing, I acknowledge that I have read, understood and agree to all the terms listed above and
confirm that all the information given on this form is correct.
____________________________ _____________________
Owner’s name and signature Date
BIYAYA ANIMAL CARE
09175433444
873 Katarungan St. Brgy. Plainview Mandaluyong City
AGAINST MEDICAL ADVICE
Acknowledgement and Waiver
Pet’s Name: Veterinarian:
I, the owner has elected not to follow the recommendations of the Veterinarian and accepts responsibility for any consequences of that decision.
The risks of not following the Veterinarian’s recommendations have been fully explained to me. I fully agree that the Veterinarian shall not be
held responsible or legally liable for the decision or any future consequences of my decision.
Recommendation/s:
[ ] Comple blood count
[ ] Complete blood count and Blood chemisrty
[ ] Cancelled surgery due medical condition/s below;
[ ] Respiratory [ ] Vomiting [ ] Diarrhea [ ] Emaciated [ ] Others, please specify
infection
By signing below, I acknowledge that I have read this information and has elected not to follow the Veterinarian’s recommendations.
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Owner’s name and signature Date
