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Public Spay & Neuter Application

  1. Public Spay and Neuter Application
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  2. Animal's Sex*

  3. Animal Type*

  4. Has the animal bitten anyone in the past 10 days?*

  5. If yes, did it break skin?*

  6. Vaccination Status, we recommend vaccination before surgery for your pets protection (Please provide proof of current vaccination history, although vaccination is not required for surgery)

  7. Medical History: If your pet is currently being treated for seizures, heartworm disease, cardiac issues, or any other preexisting condition, please note that because of the risk involved, these conditions automatically disqualify them for sterilization at our shelter.

  8. My pet DOES or DOES NOT have any pre-existing conditions.*

  9. If you would like us to vaccinate your pet please mark which vaccines you would like and prices are listed:*

  10. I authorize that this information is correct and current to the best of my knowledge. The Farmington Regional Animal Shelter will not be held liable for any circumstances including the death of my pet if any of this information has been falsified. If you miss your sterilization appointment without give 48 hours of advanced notice you will forfeit your payment.

  11. The program is income based and uses household income to determine eligibility and price. You must bring in a filed tax return, Medicaid/Medicare card or reduced school lunch program for proof of income. You must also bring in proof of residency such as an electric bill. After you bring in proof of income/residency and fill out paperwork the surgery will be scheduled. Household incomes over $60,000/yr do not qualify for our program. We also offer vaccines at the time of surgery only for $10 per vaccine.

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  13. This field is not part of the form submission.