Fix it in the Farmland Application-DOGS
This form will place you on our waiting list for spay/neuter. Please complete one form per dog.
Name
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First Name
Last Name
Mailing Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County?
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Please Select
Geauga
Lake
Ashtabula
Trumbull
Portage
Summit
Mahoning
Other
Phone Number
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Please enter a valid phone number.
Email-If you do not have email type in ehawes@rescuevillage.org
*
example@example.com
Dog's Name:
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Male or Female?
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Male
Female
Age?
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Weight? (Enter approximate if you don't know exact weight)
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Breed?
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If unknown, write "unknown"
Has the dog ever been to the vet?
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Please Select
Yes
No
Does your pet have any known medical issues? If yes, please describe below:
Is the dog up to date on their Rabies Vaccine? If yes, we will need you to provide a copy of their vaccine certificate during surgery check in. If your pet is not up to date, or you do not provide a copy of their certificate, they will receive a Rabies vaccine during surgery for an additional charge of $6. This is non-negotiable per Ohio law.
*
Please Select
Yes, my pet is current on its Rabies vaccine, I will show a rabies certificate the morning of surgery
No, my pet will need a Rabies vaccine for an additional $6
Does your pet require any special handling at the vet, such as a muzzle or sedation?
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I agree to pay the full amount of my selected services at check out.
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I agree
I agree to check my e-mail, including spam/junk folders, for important communication regarding this application
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I agree and will check my email AND spam/junk folder
I do not have email and will require a phone call
Fix it in the Farmland is a unique outreach program launched by Rescue Village in 2008. This program enables Rescue Village to provide low-cost spay/neuter services to pet owners residing in the rural areas of Geauga County. I understand that on the day of surgery my pet will be transported from the drop-off location in Middlefield to PetFix's clinic in Euclid, where they will then be spayed/neutered, vaccinated, and then transported back to the Middlefield location for me to pick up later that afternoon.
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Submit
Should be Empty: