Patterson Grant Spay/Neuter Request Form

This application is for grant funding for patients SIX months old or younger only. Valid at Sandhills Spay Neuter Veterinary Clinic (SNVC), located at 5071 US Hwy 1 N, Vass NC 28394!

Please fill out the information below. You may request the day of the week you would prefer your appointment on. We will attempt to meet your request to the best of our ability. In order to submit an appointment request online, we require a $50.00 appointment deposit. There is $2.00 processing fee for all online and credit card transactions. PLEASE NOTE: WE ARE SCHEDULING 3-4 WEEKS OUT FOR ALL FEMALE APPOINTMENTS. Once we receive your appointment request and deposit, we will email you with our first available appointment. Please allow up to 48 hours (During normal business hours, Monday-Thursday) for our response. PLEASE COMPLETE ONE FORM PER PATIENT, PER APPOINTMENT NEEDED.
Patterson Grant Spay/Neuter Appointment Request Form

Sandhills Spay Neuter Veterinary Clinic - SNVC
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
How do you prefer receiving your Pet's Records after surgery?*
Patients Name *
Do you have a Male/Female/Cat/ or Dog*

FEMALE CatMALE CatFEMALE DOGMALE DOG
If your Pet is a female, has she had her first heat cycle?

YesNo
Patients Color and Breed*
*** PLEASE NOTE THAT SOME BREEDS MAY REQUIRE A SURGICAL WAIVER TO BE SIGNED. ***
Patients Approximate Weight*
Patients Approximate Age (weeks, months)*
You can now Take a Photo or Upload a Photo of your Pet for their medical record! *
Patient Photo Upload

Cancelof
If you have a cat, are they INDOOR, OUTDOOR, BOTH, or FERAL (feral means that we can not handle the patient. Feral cats are required to come in a trap for appointments)
Are you requesting an appointment for more than one Pet? If you answer yes, please complete a new form per pet.*

YesNo
Preferred day of the week*

First AvailableMondayTuesdayWednesdayThursday
Will your Pet need a Rabies vaccine for an additional $15.00 or will you provide proof of a current Rabies vaccination? Please note, all patients are required to either provide a current Rabies certificate PRIOR to surgery, by check in for your appointment, or receive a Rabies vaccine at the time of surgery.*

Yes, my Pet will need a Rabies vaccine at the time of surgery for an additional $15.00 feeNo, I will provide a current Rabies certificate for my Pet at Check-in, PRIOR to surgery
Please provide a copy of your Pets current Rabies Certificate if available

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*** IF YOUR PET IS CURRENT ON HIS/HER RABIES VACCINE, A CERTIFICATE MUST BE PROVIDED PRIOR TO YOUR APPOINTMENT OR AT CHECK IN THE MORNING OF SURGERY. IF YOU ARE NOT ABLE TO PROVIDE PROOF OF A CURRENT RABIES VACCINE AT THOSE TIMES, WE WILL ADMINISTER A RABIES VACCINE AT THE TIME OF SURGERY. ***
Please check which additional services you would like at the time of your Pets surgery appointment

Nail Trim ($10.00)Ear Cleaning ($20.00)ProVecta Flea/Tick Prevention ($25.00-$30.00 for a 4 month supply)Microchip and registration ($30.00)Canine DHPP vaccine ($20.00)Canine Bordetella ($20.00)Canine Heartworm Test ($30.00)Iverhart Max (Canine)-heartworm prevention SINGLE month dose ($12.00)Iverhart Max (Canine)-heartworm prevention 6 month supply ($55.00)Feline FVRCP vaccine ($20.00)Feline leukemia vaccine ($20.00)Feline leukemia and FIV test ($35.00)Capstar tablet - immediate flea infestation treatment ($15.00)Upgraded Elizabethan Collar (recommended - soft rim, secure velcro) ($15.00-$20.00- based on size of pet)
**This grant funding covers the cost of surgery including, Pre-surgical exam, take home medication for post op recovery, and an elizabethan collar**

**MALE felines DO NOT receive an elizabethan collar**

**If antibiotics or other medications are needed/recommended, they are not included in your pets surgery cost**

** This application is for a grant program available for patients SIX (6) months old OR younger. If your Pet presents older than six months of age, full payment for surgery is required**
Do you have any additional information on your Pet to provide?
*** Sugery is at the discretion of our veterinarians. Surgical waivers may be required based on the physical exam of your Pet, breed, age, and/or condition.***

*** Feral cats can ONLY be brought to their appointment in a live trap ***

My Products*

Appointment Deposit ($50.00) Product Image

Appointment Deposit ($50.00)includes 4% transaction fee ($2.00)

$52.00

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Please verify that you are human
Should be Empty:

This application is for grant funding for patients SIX months old or younger only. Valid at Sandhills Spay Neuter Veterinary Clinic (SNVC), located at 5071 US Hwy 1 N, Vass NC 28394!

Patterson Grant Spay/Neuter Appointment Request Form