PRELIMINARY APPLICATION-LOW COST SPAY/NEUTER PROGRAM

PRELIMINARY APPLICATION-LOW COST SPAY/NEUTER PROGRAM
Hopeful Hearts Animal Rescue PO Box 136 Foxworth, MS 39483
NOT VALID AT VETERINARY CLINIC
Please complete this form and return with any additional information that may be required, to HHAR.
After review and approval, we will then issue you a voucher to be used at our partnered vet clinic.
Vouchers must be paid in full, at the clinic when you schedule your appointment.

If you have any questions please email us: mshopefulhearts@gmail.com
NAME
ADDRESS
CITY
STATE
ZIP
Email
example@example.com
PHONE
I receive: (check one of the following) Must show proof.
If you don't receive any of the listed options, please provide proof of income within the last month!
Medicaid
Medicare
Food Stamps
Veteran
Social Security Disability
Social Security Retirement
SNAP
Type of pet
Male Cat $50.00
Female Cat $65.00
Male Dog $65.00
Female Dog $85.00
Are vaccinations current?
Age of Pet_
Rabies vaccination is mandatory in Mississippi and is state law: If your pet has no proof of up to date rabies vaccine then one will be provided for you. Rabies vaccinations are $10.00
Breed
Name
Personal Reference
Phone Number
The low cost spay neuter vouchers are for discounted surgery only. You're party is responsible for any additional charges such as, but not limited to, sedation, or medications that may be needed after spay or neuter surgery, at time of pick up, for your pet.

By signing your name below, all information above is true and correct; you read, understand and agree to our programs terms and will not hold HHAR or affiliates liable for any unpaid cost for our spay and neuter voucher programs.
Upload attachments here

Cancelof
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

PRELIMINARY APPLICATION-LOW COST SPAY/NEUTER PROGRAM

NOT VALID AT VETERINARY CLINIC