inputSchema: type: object properties: title: Animal Sterilization Agreement pages: - id: 1 name: owner_name label: Pet Owner Full Name hint: Legal name type: text options: [] required: true - id: 2 name: owner_email label: Email Address hint: Contact email type: email options: [] required: true - id: 3 name: owner_phone label: Phone Number hint: Contact phone type: text options: [] required: true - id: 4 name: owner_address label: Street Address hint: Current address type: text options: [] required: true - id: 5 name: owner_city label: City hint: null type: text options: [] required: true - id: 6 name: owner_state label: State or Province hint: null type: text options: [] required: true - id: 7 name: owner_zip label: ZIP or Postal Code hint: null type: text options: [] required: true - id: 8 name: pet_name label: Pet Name hint: Name of animal type: text options: [] required: true - id: 9 name: pet_species label: Species hint: null type: select_one options: - Dog - Cat - Rabbit - Other required: true - id: 10 name: pet_breed label: Breed hint: If known type: text options: [] required: false - id: 11 name: pet_age label: Pet Age hint: In years type: number options: [] required: true - id: 12 name: pet_weight label: Pet Weight hint: In pounds type: number options: [] required: true - id: 13 name: pet_color label: Color and Markings hint: Physical description type: text options: [] required: true - id: 14 name: pet_sex label: Sex hint: null type: select_one options: - Male - Female required: true - id: 15 name: procedure_type label: Procedure Type hint: null type: select_one options: - Spay - Female - Neuter - Male required: true - id: 16 name: procedure_date label: Scheduled Procedure Date hint: null type: date options: [] required: true - id: 17 name: veterinarian_name label: Veterinarian Name hint: Performing veterinarian type: text options: [] required: true - id: 18 name: clinic_name label: Clinic or Facility Name hint: null type: text options: [] required: true - id: 19 name: pre_surgical_instructions label: Pre-Surgical Instructions Acknowledgment hint: Fasting and care instructions type: note options: [] required: false - id: 20 name: fasting_confirmation label: I Understand My Pet Must Fast Before Surgery hint: No food after midnight before procedure type: select_one options: - Yes I Understand - No I Need Clarification required: true - id: 21 name: health_disclosure label: Health Information Disclosure hint: I have disclosed all known health conditions type: select_one options: - Yes - All Information Disclosed - No - Additional Information Needed required: true - id: 22 name: health_conditions label: Known Health Conditions hint: List any conditions or medications type: text options: [] required: false - id: 23 name: risk_acknowledgment label: Surgical Risk Acknowledgment hint: I understand all surgical procedures carry some risk type: select_one options: - I Understand the Risks - I Need More Information required: true - id: 24 name: anesthesia_consent label: Anesthesia Consent hint: I consent to the use of anesthesia type: select_one options: - Yes I Consent - No I Do Not Consent required: true - id: 25 name: complications_consent label: Consent for Treatment of Complications hint: Authorization for additional treatment if needed type: select_one options: - Yes I Authorize - No - Contact Me First - No I Do Not Authorize required: true - id: 26 name: pain_management label: Pain Management Consent hint: I consent to pain medication as needed type: select_one options: - Yes I Consent - No I Do Not Consent required: true - id: 27 name: post_op_care label: Post-Operative Care Understanding hint: I understand post-surgery care requirements type: select_one options: - Yes I Understand - No I Need Instructions required: true - id: 28 name: follow_up_appointment label: Follow-Up Appointment hint: null type: select_one options: - Scheduled - Date Provided - Will Schedule Later - Not Required required: true - id: 29 name: follow_up_date label: Follow-Up Date hint: If scheduled type: date options: [] required: false - id: 30 name: cost_estimate label: Estimated Cost hint: Procedure cost estimate type: number options: [] required: false - id: 31 name: payment_agreement label: I Agree to Pay the Agreed Upon Fee hint: null type: select_one options: - Yes I Agree - No I Do Not Agree required: true - id: 32 name: liability_release label: Liability Release hint: I release the clinic from liability except for negligence type: select_one options: - Yes I Release Liability - No I Do Not Agree required: true - id: 33 name: owner_questions label: Do You Have Any Questions hint: null type: select_one options: - 'True' - 'False' required: true - id: 34 name: questions_details label: Please List Your Questions hint: If yes describe type: text options: [] required: false - id: 35 name: owner_signature label: Owner Electronic Signature hint: Type your full name type: text options: [] required: true - id: 36 name: consent_date label: Date of Consent hint: null type: date options: [] required: true