PAWS Spay|Neuter Info Sheet

Animal Information Sheet

Submitting this Animal Information Sheet without an approved financial assistance application you will be charged the price of our program without any other discounts, those prices are listed below: Female Dog - $92; Male Dog - $87; Female Cat $82; Male Cat - $45. Pricing is subject to change based on vet clinic's current rate. If you applied for financial assistance, you will only pay whatever the amount of your approval letter/email shows.
Pet's Name*
Pet Owner*

First NameLast Name
Email (put no@email.com if you do not have an email address we can use to confirm your appointment details)*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Owner's Birthdate*

MonthDayYear
Date
Species (Canine = Dog; Feline = Cat)*
Breed*
Gender*
Color*
Pet's DOB or Estimated Age*
Pets weight (est. is fine)*
lbs
Medical History/Illness (if none or unknown just note that)*
Allergies (if none but NKA)*
Is anything needed other than spay or neuter? If yes, you must list that here to see if if is something we can assist with*
Answering Yes to any of the below questions does not disqualify your pet from service, it just means that we or the vet may reach out to you to make the appropriate preparations for your pet's visit prior to their appointment. Example 1: If your pet is not comfortable with being crated or kenneled you would be asked to stay with your pet until they're taken back for their procedure, leave for an hour, then come back to pick your pet up. Example 2: If your dog is not comfortable with strangers or poses a bite risk at all, you would be asked to muzzle your dog or make arrangements for a slight sedative before their appointment so they do not injure themselves or anyone else. Your payment will not be refunded if you have to reschedule due to failure to notify us of your pet falling into one of the below categories at least 7 business days prior to their appointment date and if you choose to reschedule it will be at your own expense at the veterinarian's regular service rate.
Do you acknowledge the above statement and agree to answer questions A through B below honestly?*

Yes, I acknowledgeNo, I do not acknowledge
A. Is your pet comfortable with being in a kennel or crated?*

YesNo
a(1). If no, do you agree to get your pet comfortable with being in a crate or kennel prior to their procedure? We do have crates available to borrow if needed.

YesNo
B. Does your pet pose any sort of risk to vet or their staff? (biting, etc.)*

YesNo
Upload current Rabies Vaccination Certificate and any other medical history.

Cancelof
By submitting this form you hereby release Lamar County Humane Society|PAWS and the veterinary clinic where your pet's procedure is scheduled (hereafter referred to as "Veterinary Clinic"), their volunteers, employees, agents, and representatives from any liability for damage or injury caused by my pet(s) while on the premises of the veterinary clinic. I understand that Veterinary Clinic takes all reasonable precautions to ensure the safety and well-being of animals while they are under their care, accidents and unforeseen events may occur. By submitting this form I acknowledge that I am solely responsible for any actions or behaviors of my pet(s) while at Veterinary Clinic, and I agree to indemnify and hold harmless Lamar County Humane Society|PAWS and Veterinary Clinic, their volunteers, employees, agents, and representatives from any claims, damages, losses, or expenses arising from such actions or behaviors. I further understand that the Veterinary Clinic reserves the right to refuse service to any pet exhibiting aggressive behavior or posing a threat to the safety of other animals, clients, staff, or property.*

Yes, I agreeNo, I do not agree
Signature*

Clear
Today's Date*

MonthDayYear
Date
Please verify that you are human*
Should be Empty:

Animal Information Sheet