Spay/Neuter Clinic Application
Oktibbeha County Humane Society
P.O. Box 297 ▪ Starkville, MS 39760 ▪ 662-338-9093
http://www.ochsms.org
Your Contact Information:
Name (First, Middle Initial, Last): *
Your answer
Street Address: *
Your answer
City: *
Your answer
State: *
Your answer
Zip Code: *
Your answer
County: *
Your answer
E-mail Address:
Your answer
Phone: *
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Alternative Phone:
Your answer
Name of your pets' veterinarian: *
Your answer
Which clinic location would you prefer? *
Family Size Information
To be eligible for this service you must meet income level requirements. Proof of income for your entire income-earning household must be provided on day of surgery. Acceptable proof includes governmental assistance, tax returns, employment verification with annual salary.
Including yourself and all children, how many people are in your household? *
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