PMSPCA Spay/Neuter Clinic app

PMSPCA Spay/Neuter Clinic Application - Cat

Please note that we are the Pope Memorial SPCA in Concord, NH
This clinic is only for healthy cats, between 4 months to 7 years of age. Please complete this application and submit your non-refundable deposit to reserve a spot. We will review your application and reach out via email with available appointments and pre-surgery details. Pricing details are listed on our website

* Due to a large number of applications and a 1-3 month wait for an appointment, please allow us time to review your application and respond with an available clinic date. Appointments are assigned on a first-come-first-served basis. 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.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
How many cats are you bringing ? (max of 5)*
max of 5
Cat 1 - Name*
Cat 1 - Date of birth*
Can only be between 4 months to 7 years; specific date required, check with your vet if unknown
Cat 1 - Gender*

MaleFemale
Cat 1 - Weight*
or a close approximation
Cat 1 - Breed*

Short hairMedium hairLong hairOther
Cat 1 - Breed
if unknown, please indicate short/medium/long hair
Cat 1 - colors/markings*
Cat 1 - medical conditions/concerns*
Cat 1 - How does your pet act at the vet and/or with strangers?*
Cat 1 - additional vaccinations needed ? (select all that apply)

Rabies (required if not current)DistemperLeukemiaMicrochipFlea/tickLeukemia/FIV test
Cat 2 - Name
Cat 2 - Date of birth
Can only be between 4 months to 7 years; specific date required, check with your vet if unknown
Cat 2 - Gender

MaleFemale
Cat 2 - Weight
or a close approximation
Cat 2 - Breed

Short hairMedium hairLong hairOther
Cat 2 - Breed
if unknown, please indicate short/medium/long hair
Cat 2 - colors/markings
Cat 2 - medical conditions/concerns
Cat 2 - How does your pet act at the vet and/or with strangers?
Cat 2 - additional vaccinations needed ? (select all that apply)

Rabies (required if not current)DistemperLeukemiaMicrochipFlea/tickLeukemia/FIV test
Cat 3 - Name
Cat 3 - Date of birth
Can only be between 4 months to 7 years; specific date required, check with your vet if unknown
Cat 3 - Gender

MaleFemale
Cat 3 - Weight
or a close approximation
Cat 3 - Breed

Short hairMedium hairLong hairOther
Cat 3 - Breed
if unknown, please indicate short/medium/long hair
Cat 3 - colors/markings
Cat 3 - medical conditions/concerns
Cat 3 - How does your pet act at the vet and/or with strangers?
Cat 3 - additional vaccinations needed ? (select all that apply)

Rabies (required if not current)DistemperLeukemiaMicrochipFlea/tickLeukemia/FIV test
Cat 4 - Name
Cat 4 - Date of birth
Can only be between 4 months to 7 years; specific date required, check with your vet if unknown
Cat 4 - Gender

MaleFemale
Cat 4 - Weight
or a close approximation
Cat 4 - Breed

Short hairMedium hairLong hairOther
Cat 4 - Breed
if unknown, please indicate short/medium/long hair
Cat 4 - colors/markings
Cat 4 - medical conditions/concerns
Cat 4 - How does your pet act at the vet and/or with strangers?
Cat 4 - additional vaccinations needed ? (select all that apply)

Rabies (required if not current)DistemperLeukemiaMicrochipFlea/tickLeukemia/FIV test
Cat 5 - Name
Cat 5 - Date of birth
Can only be between 4 months to 7 years; specific date required, check with your vet if unknown
Cat 5 - Gender

MaleFemale
Cat 5 - Weight
or a close approximation
Cat 5 - Breed

Short hairMedium hairLong hairOther
Cat 5 - Breed
if unknown, please indicate short/medium/long hair
Cat 5 - Colors/markings
Cat 5 - medical conditions/concerns
Cat 5 - How does your pet act at the vet and/or with strangers?
Cat 5 - additional vaccinations needed ? (select all that apply)

Rabies (required if not current)DistemperLeukemiaMicrochipFlea/tickLeukemia/FIV test
Surgery costs are $200 for a spay (female) and $150 for a neuter (male). You may apply for an additional discount by showing proof of need.*

Yes, I agree to your standard costsNo, I will apply for a discount by submitting proof of need
If you selected "No", please upload proof of any local/state/federal benefits you receive. Benefits must be in pet owner's name.

IE: EBT card, unemployment, FANF, SSI, etc
Cancelof
Clinics require pre-payment in full and you will be invoiced for the balance once a surgery date is scheduled (due date is 2 weeks prior to surgery). If final payment is not made on/before the due date, your clinic spot will be cancelled and/or rescheduled.*

Yes, I agree
Signature of Owner or Animal Agent*

Clear
Spay/Neuter Clinic deposit*
prevnext( X )
Spay/neuter clinic depositNon-refundable deposit towards the total cost of the spay or neuter of your cat(s); ONE FEE PER CAT. You will be contacted with the final amount and appointment date. All payments are processed through PayPal. You may pay using an existing PayPal account, or any major credit card / debit card.
$30 # of cats

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 - Cat