Form
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Which County do you live in?
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
What is the name of your dog (dog number 1)?
*
Dog's approximate age:
*
Is your dog a male or female?
*
If your dog is female, on what date did her last heat end? It is not safe to spay a female who is not 30 days past their heat cycle. If this is the case, you will need to reapply at a later date.
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If your dog is female, is she currently pregnant or a nursing mother? We cannot spay a dog who is currently pregnant or nursing. You will need to reapply at a later date.
*
If your dog has had puppies, on what date did she stop nursing?
*
If your dog is male, are both of his testicles visible/dropped?
*
Dog's approximate weight:
*
Which number photo above is closest to your dog's body condition?
1
2
3
4
5
Does your dog have fleas?
*
Is your dog on flea preventative and/or heartworm medication? If so, please list type.
*
Does your dog have a current rabies vaccination? If so, you will need to bring proof the day of your appointment.
*
Does your dog have any health problems? Please include any other medications your dog takes.
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Name of Dog #2 (optional)
Dog's approximate age:
Is your dog a male or female?
If you dog is female , on what date did her last heat end? It is not safe to spay a female who is not 30 days past their heat cycle. If this is the case, you will need to reapply at a later time.
If your dog is female, is she currently pregnant or a nursing mother? We cannot spay a dog who is currently pregnant or nursing. You will need to reapply at a later date.
If your dog has had puppies, on what date did she stop nursing?
If you dog is male, are both of his testicles visible/dropped?
Dog's approximate weight?
Which number photo above is closest to your dog's body condition?
1
2
3
4
5
Does your dog have fleas?
Is your dog on flea preventative and /or heartworm medication? Please list types.
Does your dog have a current rabies vaccination? If so, we will be asking you to bring proof to the appointment.
Does your dog have any healthe problems? Pleae include any medications your dog is taking.
Operation Snip & Spay is a low cost spay and neuter program facilitated by Rescue Me WV. Rescue Me WV is not a service provider and is not responsible for any loss or injury arising from your participation in this program or the services rendered by any veterinarian or veterinarian’s office. It is your responsibility to ensure that the designated veterinarian is qualified and suitable to perform surgery on your pet. You must speak with the veterinarian's office to discuss any risks that may or may not apply to your pet and to discuss any concerns you may have prior to the procedure. Rescue Me WV is not responsible for any medical complications or issues that may arise during or after the procedure. By your acceptance hereto, you agreed to hold Rescue Me WV harmless from any loss, injury, or liability arising from your participation in this program.
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Please Select
I have read, understand, and accept the above, and I agree to hold Rescue Me WV harmless from any loss, injury, or liability from my participation in Operation Snip & Spay.
I understand that I will receive an email within 48 hours of submitting this application. It is important that you check you email inbox and spam folder for your letter from Rescue Me WV. Failure to complete the directions in the email will result in your application being denied.
*
Please Select
I have read and understand the above.
Submit
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