S/N clinic app

PMSPCA Spay/Neuter Clinic Application - Dog

Please note that we are the Pope Memorial SPCA in Concord, NH
This clinic is only for healthy dogs, weighing less than 55 pounds and aged 4 months to 5 years. To reserve a spot, please complete this application and submit your non-refundable deposit. We will review your application and reach out via email with an available appointment and pre-surgery details.

* Due to the number of applications and a 1-3 month wait for an appointment, please allow us time to respond with an available clinic date. If you cannot or do not want to wait for a surgery date, please do NOT complete an application, as the application deposit is non-refundable. *
Owner Name*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
How many dogs are you bringing ?*
Max of two per application
Dog 1 - Name*
Dog 1 - Date of birth*
Dog can only be between 4 months to 5 years; specific date required, check with your vet if unknown
Dog 1 - Gender*
Dog 1 - Weight
Must be at or under 55lbs
Dog 1 - Weight*
Must be at or under 55lbs
Dog 1 - Breed*
We do not accept certain breeds: Cavalier King Charles, Pekinese, Lhasa, Bulldog, Shih Tzu, Boston Terrier, Pug, French Bulldog, Japanese Chin or Tibetan Spaniels (other flat faced breeds may not qualify).
Dog 1 - Color/markings*
Dog 1 - Medical conditions/concerns*
Dog 1 - How does your dog act at the vet and/or with strangers?*
Describe behavior
Rabies (required if not current) - $40Distemper - $30Lyme - $45Kennel cough - $30Microchip - $30Flea/Tick - $35Heartworm test - $154DX test - $35
Dog 2 - Name
Dog 2 - Date of birth
Dog can only be between 4 months to 5 years; specific date required, check with your vet if unknown
Dog 2 - Gender
Dog 2 - Weight
Must be at or under 55lbs
Dog 2 - Breed
We do not accept certain breeds: Cavalier King Charles, Pekinese, Lhasa, Bulldog, Shih Tzu, Boston Terrier, Pug, French Bulldog, Japanese Chin or Tibetan Spaniels (other flat faced breeds may not qualify).
Dog 2 - Color/markings
Dog 2 - Medical conditions/concerns
Dog 2 - How does your dog act at the vet and/or with strangers?
Describe behavior
Rabies (required if not current) - $40Distemper - $30Lyme - $45Kennel cough - $30Microchip - $30Flea/Tick - $35Heartworm test - $154DX test - $35
Yes, I agree to the standard costsNo, I will apply for a discount by submitting proof of my local/state/federal assistance
If you selected "No" above, please upload proof of any state benefits you may receive.

IE: EBT card, unemployment, FANF, etc
Cancelof
Yes, I agree
Yes, I agree
Signature of Owner or Animal Agent*
Application date

MonthDayYear
Date
Spay/Neuter Clinic deposit*
prevnext( X )
Spay/neuter clinic deposit
Non-refundable deposit towards the total cost of the spay or neuter of your dog(s); ONE FEE PER DOG. You will be contacted with the final amount and appointment date. All payments are processed through PayPal. You may pay using PayPal, GPay, ApplePay or any major credit card / debit card.

$30 # of dogs

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

PMSPCA Spay/Neuter Clinic Application - Dog