Spay/Neuter Clinic Application
Oktibbeha County Humane Society
P.O. Box 297  ▪  Starkville, MS 39760  ▪  662-338-9093       
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Your Contact Information:
Name (First, Middle Initial, Last): *
Street Address: *
City: *
State: *
Zip Code: *
County: *
E-mail Address:
Phone Number: *
This phone number a: *
Alternative Phone:
Name of your pets' veterinarian: *
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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