SNIP Financial Assistance Program Application and Surgical Appointment Request Form

Thank you for your interest in a surgical appointment with the Spay Neuter Veterinary Clinic of the Sandhills located in Fayetteville, NC with a satallite location in Lumberton!

Please fill out the information below completely. You can choose the day of the week you prefer for your appointment. We do surgery Monday through Thursday, but since we serve several large groups some days book much farther out depending on the appointment that you are requesting.

The SNIP Fund is designed to assist owners on governmental financial assistance. In order to qualify for the SNIP Fund, you must be on governmental financial assistance (such as food stamps, WIC or Medicaid) and fill out this application with a picture of the qualifying proof.

This appointment request form requires you to submit the $35 payment for the appointment deposit. We are not able to schedule an appointment without the deposit.  This is only a deposit and is not the total due for surgery. If you prefer to pay the deposit in person you can come to the clinic between 9am and 3pm or give us a call, as you will not be able to submit this form. The deposit goes towards the price of surgery if you show up for your scheduled appointment, but is lost if you do not show up for your appointment or need to change the appointment with less than 7 days notice.  If you need to cancel your appointment with more than 7 days notice and are request a refund for the deposit, a $5 handling fee will be charged to cover processing fees that we are charged. 

Once the application is received with proof of qualification, we will email you the rate you qualify for and the date of your pet's scheduled surgery.  Depending on the grants available, financial assistance surgeries average $20-$30 less than general pricing.  It can take 2-3 weeks for the financial assistance program application to be processed and approved. You may not hear anything back during that time. 

We are currently booking all surgeries out approximately 3-5 weeks.

Once you receive the appointment confirmation email, confirm back to us within 48 hours that you would like that date or if you prefer a different date. If you do not let us know within the 48 hours that you would like to change the appointment date, your appointment date will be set and the standard missed or canceled appointment fees apply.

Our locations:

2709 Bragg Blvd, Fayetteville, NC 28303

1400 Linkhaw Rd Lumberton, NC 28358 (open by appointment only)

we are only able to accomidate cats and dogs weighing less than 65 lbs at our Lumberton office

Owner Information

Since some of our appointments tend to book pretty far out for some surgery types, we have a short notice appointment list that you can opt to be added to. We are always trying to add additional surgery openings and frequently are able to call owners with openings in the next day or so.

Please note we are not able to leave messages with the openings as we need to speak with the person to confirm the appointment move.  If you are on the list be on the look out for a call from us to move up your appointment.

SNIP Financial Assistance Program Requirements

• The SNIP Financial Assistance Program is only for privately owned pets who's owners receive governmental financial assistance and qualify as above.
• It is not to be used for animals not directly owned by the individual applying for the program or for animals who are being adopted out.
• A separate application and verification of proof must be submitted for each animal that wishes to be under the program. We are not able to switch animals out for another animal who does not have a current application.
  
• There is a maximum of two pets per owner per month who can participate in the program.

I understand that if I violate these policies I will no longer be eligible for the SNIP program for any animals in the future.

SNVC Deposit Policy:

The $35 deposit goes towards the price of surgery if you show up for your scheduled appointment, but is lost if you do not show up for your appointment or need to change the appointment with less than 7 days notice.

If you cancel your appointment with less than 7 days notice you will lose the $35 deposit.

If you need to cancel your appointment with more than 7 days notice and are request a refund for the deposit, a $5 handling fee will be charged to cover processing fees.

If you are on the SNIP Financial assistance program and you do not show up for your appointment or cancel within the 7 days prior to your appointment, that pet no longer qualifies for financial assistance and you will need to pay a new deposit and the full surgery price to reschedule.

I understand and agree to the deposit policy as stated. I understand that if I have any questions about payments made or would like to request a refund of any credit on my account, I should contact SNVC directly for that request. Any individual or account who initiates a bank or credit card Charge Back request against any amount paid to SNVC, not just this deposit, will incur a $50 finance fee and will not be seen by SNVC for any services until the account is cleared all money owed with a cash payment. In such case, the account or individual will be served on a cash only basis after the due amount is cleared and the individual will not be eligible for discounts or financial assistance.

Please read and sign below:

I, acting as owner or agent of the pet named above, hereby request and authorize SNVC to perform an operation for sexual sterilization of the animal named above.

• I understand that any anesthetic/surgical procedure, including surgical sexual sterilization, presents a degree of risk to the patient and, though minimal, may result in injury or death.
• I certify that my animal is in good health and not on any medications other than those disclosed.
• I understand the inherent risks of failing to maintain current vaccinations and waive all claims arising out of or connected with the performance of this operation or due to such failure.
• I understand that some factors significantly increase surgical risk, including but not limited to; pregnancy, being in heat, recently post-partum, obese, brachycephalic or over 7 years in age, having a heart murmur and diseases such as Feline Immunodeficiency Virus (FIV), Feline Leukemia, and heartworm disease.
• I understand that blood work and/or veterinary diagnostic prior to surgery is recommended for all high risk pets.
• I understand that if my pet has a pre-existing medical condition, clinical or subclinical, this condition may be worsened by anesthesia and/or surgical sterilization.
• I understand that if my animal is pregnant, the pregnancy will be terminated at surgery.
• I understand that SNVC has the right to refuse service to any animal determined to be ill or at increased risk. Sick animals are at higher risk for anesthetic and surgical complications, as well as pose a risk to other animals in the clinic.
• I understand that SNVC may not perform a complete physical examination before surgery is performed. I also understand that my animal will not receive pre-operative blood work unless requested and waive my right to have this service performed prior to surgery.
• I understand that if there are complications my pet may need to receive post-operative monitoring or care at an emergency clinic and I accept the financial responsibility for that care if deemed necessary by the veterinarian.
• I understand that my animal should have no food after 12:00 midnight the evening prior to surgery (excluding pets less than 4 months old).
• I understand that if my animal has an open umbilical hernia, it may be repaired at time of surgery for an additional fee.
• I understand that if my male animal is a cryptorchid there will be an additional fee for surgery.
• I understand that photographs may be taken during the day, and my pet may be present in those photos. I understand that the photographs taken at SNVC may be used for promotions and advertisements for SNVC. This includes but is not limited to Facebook, Twitter, SNVC website, advertisements, etc.
• I understand that if I do not retrieve my pet at the agreed upon time, SNVC may exercise their right to turn the animal over to the nearest animal control center, humane society, or dispose of as deemed just and proper as allowed by the State of North Carolina under G.S. 90-187.7(a). Owners of pets left after closing at 5pm will be charged a 25.00 per half hour late fee. Owners dropping Pets off past the intake time of 8:00am will be charged a 25.00 late drop off fee and may be turned away for surgery and asked to reschedule.
• I understand that payment in full is required prior to services being rendered.
• I agree to allow SNVC to run any Credit Card(s) on file to cover any remaining balance due. Payments may be processed after the day of surgery.
• I understand that under no circumstances will the Spay Neuter Veterinary Clinic pay for services received at another veterinary clinic, whether the services are related to a surgery done at the Spay Neuter Veterinary Clinic or not.
• I understand that there will be a small permanent green line tattoo next to the incision indicating sterilization.
• I understand that my animal may receive a nail trim and occasionally nails are quicked in the process.
  
• I understand that my animal's fur will be shaved to ensure sterility during the surgical procedure.
• I understand that if the Clinic has any questions regarding your pet or there is reason for concern or increased risk with surgery noticed prior or during surgery, the clinic will attempt to reach the owner at the numbers left at check in. IF THE OWNER IS NOT REACHABLE BY 10AM DAY OF SURGERY I UNDERSTAND THAT SURGERY MAY NOT BE DONE ON MY ANIMAL and you may need to reschedule your appointment
• I hereby release the Spay Neuter Veterinary Clinic of the Sandhills, all veterinarians, assistants, volunteers, directors, and employees from any and all claims arising out of or connected with the performance of this procedure or any adverse reactions from vaccinations. I agree that I have not and will not claim any right of compensation from any of the above, or file action by reason of such sterilization or attempted sterilization of such animal or any consequences related thereto. Owner/agent hereby agrees to hold SNVC unaccountable for any damages caused during the transportation of the animal, or for any damages caused by any unforeseeable events including fire, vandalism, burglary, extreme weather, natural disasters or acts of God.