This has been our vet for many years. True, the cost of spay and neuter does not include the meds after surgery, or monitoring during, however the additional cost for these things is very little. They do provide pain relief before surgery. Even with that bit of extra money, the cost is well below normal vets, and the care that is given is far superior to others we have been to. If you are a dog owner, they even provide free nail trimming while your dog is under. My pets are my family, and I trust Helping Hands completely with their health and care.