Vaccine Clinic Registration

Thank you for your interest in coming to our vaccination clinic! This is a registration form for the upcoming vaccination clinics.

PLEASE CHOOSE WHICH VACCINATION CLINIC YOU PLAN ON ATTENDING IN THE DROP DOWN MENU BELOW!

This request is for vaccinations at a vaccine clinic and NOT for surgery. For surgery appointment requests please fill out the surgery request form available here.

Please fill out the information below completely so that we can pre-enter you and your pet into our system. We will add the services requested and will send you a payment request. We encourage you to pay at least 48 hours prior to the vaccine clinic so that we can have everything prepared for you when you get to the clinic. This will greatly speed up the registration process and allow you to process through the vaccine clinic faster. Please still expect some wait time as the vaccine clinics tend to be well attended and although we go as fast as possible, there is still a wait.

Our veterinary clinic building is located at 2709 Bragg Blvd, Fayetteville, NC 28303 BUT the Vaccination Clinic is held at an alternate location.

Cats must be brought in an individual carrier. Feral cats will not be seen as they may need to be sedated to receive services.

Dogs must be leashed and contained. Aggressive dogs should be muzzled and properly restrained by the owner.

Tentative Schedule of 2025 Vaccination Clinics:

February 8th – Hoke County

March 15th – Sanford/ Lee County, Carolina Town & Country, 710 E Main St, Sanford, NC 27332

April 12th – Sandhills Dog Fair, Pinehurst, Moore County

July 19th – Robeson County

September 20th – Sanford/ Lee County, Carolina Town & Country, 710 E Main St, Sanford, NC 27332

Please check back frequently as new dates and times will be added

PLEASE CHOOSE AN UPCOMING VACCINATION CLINIC LOCATION*

Owner Information

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Email*

example@example.com

Cell Phone Number - If you do not have a cell phone number, please provide another number were we can reach you during regular business hours*

Home Phone or Alternate Number

Pet Related Appointment and Health Questions

What is your Pet's name?*

Is your pet a Cat or Dog?*

Dog Breed*

Cat Breed*

Color & Markings*

Approximately how much does your pet weigh?*

In pounds

Date of Birth - If Known, otherwise fill out Approximate Age below:

Date

Approximate Age:

Gender?*

Please indicate where your cat primarily lives.*

WE ARE UNABLE TO SAFELY HANDLING AND VACCINATE FERAL CATS AT A VACCINE CLINIC AS THEY MUST BE BROUGHT IN A TRAP AND MAY REQUIRE SEDATION TO BE SEEN DEPENDING ON SERVICES REQUESTED

Has your pet had any recent health concerns?*

YesNo

Please explain*

Services Related Questions

Will your pet need a rabies vaccine for $15 or will you be bringing or attaching a rabies certificate? Please note that one or the other is REQUIRED if your pet is over 12 weeks of age.*

Yes, my pet needs a rabies vaccine for $15No, I will bring a rabies certificate or will attach one below (preferred)

Please upload a picture of the Rabies Certificate if you have one:

Browse Files

What additional services does you Dog need?*

	Yes	No
Microchip - $25 We recommend Microchips for all Pets as a permanent form of identification.
DHPP (Distemper, Hepatitis, Parvo & Parainfluenza) - $20 Considered a core vaccine & recommended for all dogs.
DHPP + Leptospirosis - $30 If your dog spends time outside or is potentially exposed to wildlife we recommend Canine DHPP + Leptospirosis Vaccine instead of the regular DHPP vaccine
Bordetella - $20 Also known as Kennel Cough, this Vaccine is often required by groomers and boarding facilities
Deworming - $20-$40 Deworming is based upon weight at time of visit.
Canine Influenza- $55 This vaccine protects against canine influenza (different from kennel cough) and is required by some groomers, boarding facilities and doggie daycare.

What additional services does you Cat need?*

	Yes	No
Microchip - $25 We recommend Microchips for all Pets as a permanent form of identification.
FVRCP (Feline Viral Rhinotracheitis, Calicivirus, Panleukopenia) - $20 Considered a core vaccine & recommended for all cats.
Feline Leukemia Vaccine - $25 Recommended for all cats that go outside. Strongly recommended to test cats prior to vaccination.
Deworming - $20 Deworming covers all the major parasites, including tapeworms.

Does your pet need any flea and tick prevention? We offer Bravecto for $70 which lasts for 3 months. Bravecto can only be used in pets 6 months or older.*

YesNo

You can buy up to 4 doses of Bravecto per patient. How many would you like to purchase?*

Would you like to purchase a monthly topical preventative for you Cat to cover them for Fleas, heartworms, intestinal parasites and ear mites? We offer the topical for $60 for a 3 month supply.

YesNo

For the Hoke County clinic only: we are offering a promotion for heartworm prevention for the month of February! Heartworms are spread by moquitoes and cause worms to live in your dog's heart. This leads to heart failure and eventually death. We are hoping to bring attention to how serious heartworm disease is and how easily it is prevented.

We are offering a FREE heartworm test ($30 value) for your dog with the purchase of a years-worth of heartworm prevention. You can purchase a years worth of oral Iverheart Max, Parasedge or two ProHeart 6 injections to qualify for the free heartworm test.

Does you Dog need a Heartworm Disease Test for $30? This test is required yearly to purchase Heartworm Prevention Medication for all dogs over 6 months of age. In NC it is recommended that dogs are on Heartworm prevention year round.*

YesNo

With a heartworm test performed by us or proof of negative heartworm test, you can purchase Heartworm prevention for your pet. We offer a monthly chewable and an injectable heartworm prevention that lasts for 6 months with one shot. You can choose either option or we can help you decide!

For the monthly oral heartworm prevention, we offer Iverhart Max for $60 per 6 month package. It covers heartworms as well as most intestinal parasites, including tapeworms. Would you like to purchase Heartworm Prevention for your pet?*

YesNo

How much Heartworm Prevention would you like to purchase? *

For pets over 6 months of age, we offer the ProHeart 6 injection which provides 6 months of heartworm coverage in one injection. You will need to schedule for a second injection in 6 months to be covered for the entire year. Pricing is based on weight (0-50lbs $65, 51-74lbs $85, 75-100lbs $135 ask if above). Would you like your pet to have a ProHeart 6 injection?

Yes - 6 months (1 injections)No

Any additional information regarding your pet? Known medical conditions or other information that would be relevant for us to know when scheduling your appointment?

Please read and sign below:

I, as the person with authority to make decisions regarding the above listed pet’s care, hereby authorize the selected services for my pet.

I certify that my animal is in good health and not on any medications other than those disclosed.
I understand the exam performed may be a brief exam to determine if the pet is healthy for vaccines and is not considered a complete physical.
I understand the inherent risks of failing to maintain current vaccinations and the possibility of vaccine failure. I waive all claims arising out of or connected with the performance of these services or due to such vaccine failure.
I understand that vaccination reactions can happen and include: facial swelling, hives, reddened skin, itching, excessive swelling/ scratching at the injection site, pain at injection site, excessive drooling, lethargy, decreased appetite, vomiting, diarrhea, anaphylactic shock and / or death. I understand that vaccine and medication reactions are idiosyncratic and cannot be predicted. If there is a vaccine reaction, I authorize SNVC to perform any procedures deemed necessary to treat my pet.
I understand that feline Feleuk and FIV testing is recommended for kittens and annually afterwards, especially prior to vaccination.
I understand that heartworm testing is always recommended prior to administration of any heartworm prevention.
I understand my medications given may not be in a childproof container.
I understand that SNVC has the right to refuse service to any animal determined to be ill or at increased risk. Sick animals are at higher risk for complications, as well as pose a risk to other animals in the clinic.
I understand that if there are complications my pet may need to receive post-operative monitoring or care at an emergency clinic and I accept the financial responsibility for that care if deemed necessary by the veterinarian.
I understand that photographs may be taken during the day, and my pet may be present in those photos. I understand that the photographs taken at SNVC may be used for promotions and advertisements for SNVC. This includes but is not limited to Facebook, Twitter, SNVC website, advertisements, etc.
I understand that payment in full is required prior to services being rendered.I understand that all sales are final and no refunds are permitted for services or medications.
I understand that under no circumstances will the Spay Neuter Veterinary Clinic pay for services received at another veterinary clinic, whether the services are related to a treatment or procedure done at the Spay Neuter Veterinary Clinic or not.

I will not hold the veterinarian, their employees, volunteers, family members or SNVC responsible for any issues arriving from the procedures performed, such as vaccine or medication adverse events.
I hereby release the Spay Neuter Veterinary Clinic of the Sandhills, all veterinarians, assistants, volunteers, directors, and employees from any and all claims arising out of or connected with the performance of this procedure or any adverse reactions from vaccinations. I agree that I have not and will not claim any right of compensation from any of the above. I as the owner/agent hereby agrees to hold SNVC unaccountable for any damages caused during the transportation of the animal, while entering or exiting the service location, or for any damages caused by any unforeseeable events including fire, vandalism, burglary, extreme weather, natural disasters or acts of God.
SNVC does not offer hospitalization, radiology or emergency care. If there are any questions or concerns directly related to the services provided, please call this office at (910)400-7682 and press 3. If there is an emergency after hours, contact your regular emergency veterinarian or contact Points East Veterinary at 910-864-2844.

Date Signed (Hidden Field)*

Date

Signature*

Vaccine Clinic Registration Form