Spay and Neuter Application

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

County*

Email*

example@example.com

Phone Number*

Area CodePhone Number

Dog Name*

Dog Breed*

Male/Female*

Dog Age*

Dog Weight*

Is Dog current on Rabies Vaccine?*

Is Dog current on Distemper Vaccine?*

Is Dog Microchipped*

Is Dog on Heartworm Prevention*

Does the dog live in the home or outside?*

If the dog lives outside, are you willing to keep inside for 1 week to heal from surgery?*

Number of Unaltered Dogs in Home*

Are you willing to have all dogs in home altered?*

If NO to question above, why?

Do you need transportation help getting dog to and/or from appointment?*

Please describe the reason you need help getting your dog(s) Spay/Neutered*

TERMS and CONDITIONS:

I understand I am required to make a $25 non-refundable deposit.

I understand that the photo I supplied Big Hearts Big Barks Foundation of my dog might be used for marketing purposes.

I understand that Big Hearts Big Barks Foundation and participating veterinary clinics are not responsible for any additional costs associated with the surgery on my animal.

I will be responsible for additional costs not associated with Spay/Neuter, but will be consulted by the veterinarian before additional services are performed for my pet.

I understand that once my appointment is scheduled, if I fail to take my pet to the agreed-on meeting place on the day and time agreed upon, my application can be cancelled and paid deposit is forfeited.

If you have an emergency or see you cannot take your pet on the day assigned, please contact us as soon as possible.

I agree the participating veterinary clinic and Big Hearts Big Barks Foundation will not be liable for complications or health issues from the surgery. Any other medical care the dog receives except for spay/neuter will be the responsibility of the owner.

I will comply with the rules as outlined in this agreement. If your dog is pregnant or in heat let us know. There will be an extra fee.

Please click “SUBMIT” to submit this application along with a photo of your dog.

Failure to compete all components (including photo) will result in your application not being processed.

Upload Photo of Dog Here*

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