NOTE: COMPLETING THIS FROM DOES NOT BOOK YOUR APPOINTMENT.
You should have received a separate email confirming your appointment. If you have not received that email, your appointment may not have been booked. You can book appointments at this link.
Thank you so much for scheduling an appointment with our rescue clinic!
This form should be completed the night before the surgery. We cannot accept cats for surgery until this form is completed and received into our system.
Appointment Date *
Name of Person Appointment is under *
The appointment date comes from the appointment you booked at this link. . If you have not paid a fee and have a booking number you do not have an appointment and should not fill out this form as it will be ignored.
Rescuer Information
The Rescuer who is responsible for this cat MUST have a user form on file with contact information and a liability release. It only needs to be completed once unless your contact information changes. If you have not completed one before you must complete one before we can see your cat. You can complete the form at this link.
Name of Rescuer who is responsible for cat *
Has the cat been to this clinic before? *
No Yes
Animal Name *
Is the cat feral? (Unfriendly and not handleable) *
Yes
No
Unsure
Species *
Cat
Cat
breed *
Domestic Long Hair
Domestic Medium Hair
Domestic Short Hair
Other
Coat Color/Markings *
How old is the cat? Estimate is fine or put unknown. *
Sex? (Please select) *
Male
Female
Unknown
Please provide as much background as possible so we can provide the best care for the cat.
Has she had a litter? *
Yes
Currently Nursing
Suspect Pregnant
No
Unsure
Is the cat eating and drinking normally. *
Yes
No
Unknown
Any recent noticeable change in weight? *
Stable
Weight Loss
Weight Gain
Unknown
When will food be taken away from the cat before surgery? We recommend 11pm the night before procedure for Adults and 5am the morning of the procedure for kittens under 4 lbs. *
Does the cat have any current medical conditions (including coughing, sneezing, vomitting or diarrhea) that you are aware of? *
No Yes
If yes, please describe *
Has this cat had any flea treatment or vaccines? Please provide dates if known. *
No Yes
What flea or vaccine treatments has the cat received? *
Is the cat taking any medications? *
No Yes
Please describe any medications the cat has been given in the last 30 days. *
Was this cat trapped? *
No Yes
When was the cat trapped? *
Is this cat owned or homeless? *
Owned
Homeless
Is this cat part of a colony/group of cats? If yes, how many cats are part of the colony/group? *
No, this cat was found on its own and to my knowledge, is not part of a colony/group of cats.
Yes, there are 5 or less cats in the colony/group.
Yes, there are 6-10 cats in the colony/group
Yes, there are 11-15 cats in the colony/group
Yes, there are 16-20 cats in the colony/group
Yes, there are 21-30 cats in the colony/group
Yes, there are more than 30 cats in the colony/group
If the cat is part of a colony/group, how is it currently managed? *
The colony is not currently managed.
The colony is fed but no TNR has previously been conducted.
The colony is fed and TNR efforts are ongoing.
The colony is fed and TNR efforts are complete.
TNR efforts are ongoing but the colony is not fed
Address, Neighborhood and/or zip code of where the cat came from *
Where did the Owner get the cat? *
Friend/Relative
Pet Store
Purchased
Rescue
Found
Store/Bodega Cat
What Borough Does the Cat Live in? *
Brooklyn
Bronx
Manhattan
Queens
Staten Island
Outside NYC
Is the cat an indoor only, outdoor only, or indoor/outdoor cat? *
Indoor only
Outdoor only
Indoor/outdoor
Any additional information we should know about this cat? *
Each cat will have a pre-surgical exam (post sedation for feral cats or those who can’t be handled), be given an FVRCP and Rabies, flea treatment and a microchip all included in the reservation price. Extra charges apply for spay (+$20), pregnant spay (+$35), cryptorchid neuter (+$20).
Post anesthesia the veterinarian may find that the cat requires additional treatment for medical conditions discovered during a sedated exam including Convenia (injectable antibiotic), Drontal (for tapeworms), infected ears and ear mite treatment. These conditions will be treated and additional charges will apply. Signing the form below indicates your understanding and agreement to these treatments.
Please select the services you need that are included in the cost of surgery (pick all that apply). You will need to provide proof of previous rabies and FVRCP vaccine if not being done today. *
Sedated Exam (No Surgery)
Spay or Neuter
Rabies
FVRCP
Ear tip
Flea Treatment
Microchip
Other Surgery (requires prior discussion)
What additional medical services do you need (pick all that apply)? *
Fecal Test ($55) Bring a fecal sample to appt
Ear Cleaning with Ear Mite Treatment ($20)
Nail Trim ($2)
Take Home Dewormer ($10)
FeLV/FIV ($25)
Please note that any questions or concerns regarding post surgical issues should be emailed to clinic@bbawc.org. The clinic is not open every day but this email will be monitored. If the cat is in distress and you feel there is an emergency please take the cat to an emergency hospital and do not wait for a response.
I being of legal age (18 or older) and lawfully authorized to make decisions on behalf of the animal described above (the "Cat") hereby agree to the following:
Consent for Surgery, RIsks associated with Surgery and Anesthesia
I heareby authorize and give my consent to BBAWC to receive, prescribe for, treat and/or perform sterilization surgery and/or administer vaccinations and/or microchips as indicated above. I understand that the cat may have medical issues that are unknown to BBAWC and therefore the Cat may be at greater risk for surgery. I understand that the likelihood of such unknown or undisclosed medical issues is higher in an animal that is considered to be feral. I recognize that feral cats cannot be handled by the medical staff while awake and can only be examined after anesthesia. I understand that so long as, in the opinion of the attending veterinarian, it is determined that the animal is an acceptable surgical and/or vaccination candidate, sterilization procedures and/or vaccinations will be performed regardless of the Cat's sex or or medical condition (including pregnancy). I understand that the Cat could die during or after anesthesia or surgery, and that these risks are more likely to occur if I did not follow pre-surgery feeding instructions. I understand that modern techniques and trained staff will be used to care for all animals and reasonable precautions will be used against injury, escape or destruction of the Cat. I understand that the Cat will receive a small tattoo on his or her underside to show that he or she has been sterilized.
I understand that every effort will be made to achieve a successful outcome and to provide for the safety of both humans and animals at the clinic. I understand and agree that BBAWC shall not be liable to or held responsible by me in any manner for, or in connection with, the procedure to be performed on the Cat, and I hereby hold BBAWC harmless from and against any and all liability and damages that may arise. I understand the Cat shall be administered with a local and/or general anesthesia for surgery. If, in the course of treatment or during the procedure, a condition is discovered which requires medical attention or additional procedure(s), I consent that the attending veterinarian may, in his or her absolute and sole discretion, perform such a procedure without seeking additional authorization or consent from me. I consent to these procedures and agree to pay for them. I understand that the medical staff can refuse to perform a procedure on any animal for any reason. Such refusal is the sole discretion of the BBAWC attending veterinarian.
Post Operative Care and Complications
I will take full responsibility, financial and otherwise, if the Cat becomes ill after surgery. I understand that BBAWC Surgery clinic has limited medical staff and that if there are complications I must email clinic@bbawc.org with concerns. I understand that if there is a life threatening issue before BBAWC can respond I am responsible, financially and otherwise, for taking the Cat to a twenty four hour emergency clinic.
Hold Harmless
I understand that every effort will be made to achieve a successful outcome and to provide for the safety of both humans and animals at the clinic. To the fullest extent permitted by applicable law, you shall indemnify, defend, save and hold harmless BBAWC, its officers, directors, employees, agents, successors and assigns from and against any and all losses of any nature that arise out the services provided at this clinic.
I hereby warrent that (A) I am over 18 years of age, (B) have read this agreement carefully prior to its execution, (C) fully understand this agreement, (D) realize this agreement is an enforceable legal document between myself and BBAWC and (E) voluntarily sign this agreement of my own free will.
Please Type first and Last Name *
Email of person filling out form *
Signature and Agreement (sign with finger or cursor) *
Clear