Surgery Drop Off Questionnaire


Please complete this form before your visit.

Additional services requested:
I hereby authorize The Cat Doctor of Monroe and Dr. Kimberly Scutchfield to use sedation and/or general anesthesia on my pet. I understand that sedation and anesthesia pose a risk to my pet, regardless of health status. In the event of unforeseen complications, I give permission for the doctors and staff to take reasonable measures in treating my pet and accept all charges that are incurred as a result of such action. As the owner or appointed caregiver, I understand that by signing below, I agree to pay for all charges +/-15% of the fees for my pet’s procedure and will pay the balance in full upon discharge of my pet. The sedation and/or anesthesia and relevant procedure costs have been fully explained to me to my satisfaction. If there is evidence of fleas (live fleas, flea feces) we will administer a flea treatment to your cat and you will be responsible for the cost of the medication.
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