Application for Dog Spay/Neuter Assistance
Please submit one form per animal. Call or text (540) 319-9945 for help with the application. If you give us your email address, we will email you the voucher. We will mail you the voucher if you do not have an email address. The voucher is for your records- you do not need a copy for the appointment.
Your Name *
Mailing Address *
Locality *
Phone Number *
Email Address
Please leave blank if you don't check it regularly
Name of Pet Needing Spay/Neuter *
Pet's Breed *
Pet's Gender *
Pet's Age *
Accurate assessment of the pet's age is important. Dogs over 6 years old require blood work to ensure that they are healthy enough for surgery.
Pet's Weight *
Has your animal ever been seen by a veterinarian? *
If yes to above, what is the name of your veterinarian or your preferred veterinarian?
This information is helpful when trying to match you with one of our partner veterinarians.
Does your dog have a current rabies vaccine? A current vaccine is required to get your dog tag with the localities, which is required by our program. *
Number of people in your household *
Monthly Household Income *
Income before taxes taken out. Income limits apply.
Source of Income *
Required
Why do you want your dog spayed/neutered?
Need help getting your cat fixed? Cats Unlimited offers $30-40 cat spay/neuter. Call (540) 458-2287 to apply. http://www.catsunlimited.org/SpayNeuter.html
Questions or Comments
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