Spay/Neuter Form

P.A.W.S. LOW COST SPAY/NEUTER PROGRAM

Application Date: _______

Owner’s Name: ______________________________________________

Owner’s Phone Number(s): ____

PET INFORMATION

Owner’s Email:

City: ________________________________

____________

__

______________

Pet Name: _________________________

Cat or Dog

Male or Female

Pet Age: __________*

Have Vaccine Proof? Yes or No

Pet Name: _________________________

Cat or Dog

Male or Female

Pet Age: __________

Have Vaccine Proof?

Pet Name: _________________________

Cat or Dog

Male or Female

Pet Age: __________

Have Vaccine Proof? Yes or No

Breed of Dog:

For office use ONLY:

Approx. Weight:

Is your pet in heat or pregnant?

Circle One

PAYMENT TOTALS (Low Cost / Low Income) Number of Dogs (SPAYING or Neuter) __________ X $ 75 / $ 50 = __________________ Number of Cats (SPAYING or Neuter) __________ X $ 65 / $ 40 = __________________ Paid by Cash __ Credit Card __ or Check #___________ Date Received: _______________

Yes

No

Yes or No

_

Check Box Below If Qualified for Low Income

Medicaid

Food Stamp

Senior Discount (65 or over)

Total Received = _____________________

Appointment Date:_______________________________ Veterinarian: Animal Clinic of Saint George or Washington Family Vet Animal Clinic of Saint George – Dr. Ball (857 E. Tabernacle), 673-9696. ***No Food after midnight the night before appointment, a minimal amount of water is okay. Have your pet to this Vet’s office between 8:30 AM – 9:30 AM. A pick up time will be discussed upon drop off. *NOTE: If your pet is 8 years or older, you will be required to pay for a blood test before anesthesia can be administered ($72). Washington Family Vet – Dr. King & Dr. Barton (969 N 3050 East B1 – A) 627-1300. This Vet’s office is located behind Albertson’s Grocery Store and before Costco & Sportsman’s Warehouse. ***No food after 8 PM the night before the appointment, but water is okay. Have your pet to this Vets office between 7:00 AM - 8:30 AM. When you drop your family pet off for surgery a pick up time will be discussed. WILL NOT TAKE PETS UNDER 6 MONTHS.

*Fill out additional form if going to Washington Family Vet Additional Information regarding your animal’s upcoming spay or neuter appointment: ***Please bring proof of vaccines with you to the Veterinarian’s office. If you do not have proof of vaccines the Vet will vaccinate your pet at an additional charge (approx. $38-40 for dogs & $37-40 for cats). If your animal is in heat or pregnant we would prefer that you wait to have them spayed as this will be an additional charge for you of $35 to $75 payable to the Vet. Animals 60 lbs. incur an additional charge of up to $30 and pets 100 lbs or over are charged more at the Vets discretion. Pain or other medication if prescribed by the Veterinarian is also an additional charge of $21, for which you will be responsible to pay. Other veterinary services can be quoted to you upon request. If you have any questions please contact PAWS at 688-9748 or the Veterinary Office.*** P.A.W.S. – Providing Animals with Support, Thanks You for being a responsible pet owner.