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Volume Client Application

Primary Contact Information

Are you a 501(3)c

Secondary Contact

Surgical Consent

All surgeries & use of anesthetic drugs present some risk of complication, possibly including injury/death. In the event of an emergency (respiratory or cardiac arrest) WCVC staff will contact you. In this event, for all animals undergoing surgery:
YES, please perform CPR. We will cover any costs incurred.
NO, DO NOT RESUSCITATE. We understand the animal likely will not survive.
If we are UNABLE to perform a pre-surgical exam on this patient due to behavior, may we proceed with surgery?
Yes
No
If an animal presents for surgery and a suspected spay scar is discovered once they are sedated and prepped, would you like us to:
Surgically confirm they are spayed.
NOT perform surgery & wake the animal up.
Always contact us for each animal.*
If an animal presents for surgery and one or two retained testicles are discovered once they are sedated and prepped, would you like us to:
Surgically confirm they are neutered in the case of no evidence of either testicle or physical charastics of a neutered male.
Perform the surgery to locate a single missing testicle.
Always contact us first for each patient.*
Do not continue, wake the patient up.
If an animal presents for surgery and an umbilical hernia is discovered once they are sedated and prepped, would you like us to:
Repair the defect at additional cost.
Do not repair the defect.
Always contact us for each animal.*

* I understand that selecting “contact me first” options may mean re-sedating the animal at a later date if we are unable to reach you immediately. Any additional costs will be the responsibility of the volume client.

Payment Preferences

I understand that services must be paid for as they are rendered and will provide payment after each visit. Payment can be made by credit card, or by check (with a valid driver’s license only). Check one box for payment method of choice:
Our organization will provide payment by check by mail after invoicing.
Send me an invoice link.
Keep our credit card on file. I authorize WCVC to process payments as services are rendered.
I would like to set up portal access and pay by credit card through my portal.
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