Low cost spay/neuter form

Spay/Neuter Form Richardson Rescue 803-684-6865

* First Name

* Last Name

* Street Address

Address Line 2

* City

* State

* Zip Code

* Phone Number

Email Address

* Where did you hear about our rescue group?

* How many incomes in the family?

* Are you recieving one of the following?

* Occupations of everyone in the home.

* Total household Income

* The above income is based on one of the following:

* Names and discription of animals to be treated. Please indicate sex, age and size.

* Are your animals vaccinations current?

Yes

No

* Name and number of current Vet

* Date of Rabies shot

* Date of DHLPP (Dog)

* Date of FeLv/Fiv (Cat)

If these shots are not up to date that will need to be given the day of surgery at an extra charge.

* Are any of these animals feral or aggressive?

Yes

No

Unknown

* If Yes please explain.

* I understand that during the performance of my pets spay/neuter there are risks involved when using anesthetics and or other medications and complications can occur not excluding death. Richardson Animal Rescue and all Veterinarians will not be responsible for any complications.

Yes

No

* Indicates Response Required


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