SNAP Application

Sandhills Spay Neuter Veterinary Clinic

5071 US Hwy 1, Unit C Vass, NC 28394

Phone: 910-725-8188 Email:Info@spayurpet.org
If you receive or qualify to receive public assistance such as Food Stamps or Medicaid, you may qualify to participate in the Moore County SNAP Program which will cover the cost of spay/neuter surgery for your pet.
Please submit the completed, signed form to the Sandhills Spay Neuter Veterinary Clinic (SNVC) with required proof. Surgery Appointments are Required. A deposit of $10.00 will be required by Sandhills SNVC in order to schedule your appointment once your application has been approved.
Name *

First Name Last Name
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City County

State / Zip Code
Daytime Phone Number *
Please enter a valid phone number.
Cell Phone Number *
PET INFORMATION:
Pet Name *
Dog or Cat? *

Dog Cat
Breed *
Age (weeks, months, or years) *
Color *
Sex *
Estimated Weight? *
If female, has your pet had a litter of puppies or kittens? *
If yes, please list the date of your Pets last litter

Month Day Year
Date
Does you Pet need a Rabies Vaccine? Proof of rabies vaccination is required *

Yes, my Pet will need a Rabies Vaccine No, I will I will bring proof of my Pets current Rabies vaccine
I qualify for the Moore County SNAP assistance because I receive (check all that apply) *

Food Stamps/EBT WIC Medicaid Section 8 Housing
Please attach a copy of your assistance *

Cancel of
Please attach a photo of your current NC Drivers License *

Cancel of
Signature *

Clear
Today's Date: *

Month Day Year
Date
I would like to pay my appointment deposit now
prev next ( X )
Appointment deposit SNAP appointment deposit
$ 10.00

Total

$ 0.00
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PET INFORMATION: