Spay/Neuter Services:

PHYSICAL EXAM/ SURGICAL REPORT

Date:_______________________________

Patient ID #: ________________________

Patient description:_____________________________________________________

______________________________________________________________________

Sex: (circle)                MALE                        FEMALE

Estimated age:_______________________

Surgeon: ___________________________

Physical examination: (circle normal(N) or abnormal(A)- if abnormal provide details)

eyes                N         A         face                 N         A         abdomen         N         A         

ears                 N         A         skin                 N         A         lymph nodes   N         A

mouth             N         A         heart                N         A         mammary       N         A

nose                N         A         lungs               N         A         genitals           N         A

Details of abnormalities:

Examined prior to anesthesia :           Yes                 No (If no-too fractious)

Surgical report:

Surgery:(circle)          Spay                            Neuter

closure:           linea:___________________________

                        subQ:___________________________

                        skin:____________________________

Recovery: (circle)      normal            abnormal (provide specifics)