PLEASE COMPLETE THIS FORM
Click image
for FAQs
CAT APPLICATION
First Name:
Last Name:
Street Address (NO P.O. BOX):
City:
State:
Day Time telephone number:
Evening telephone:
Emergency telephone number:
Have you ever participated in our program?
YES
NO
How did you hear about us?:
Which clinic would you like to use?
Kincheloe Clinic, Spotsylvania, VA
Prevent a Litter, Richmond, VA
Shenedoah Valley Clinic (transport available)
Faquier SPCA Clinic, Casanova, VA
National Capital Spay/Neuter Clinic, Washington, D.C.
What is the name of your regular veterinarian:
Has your pet visited your veterinarian in the past six months?
YES
NO
Is your pet a dog or cat?
Dog
Cat
Pet’s Name:
Pet’s Age:
What is your pet's approximate weight?:
What is the gender of your pet?
Male
Female
Does your pet have long hair or short hair?
Long Hair
Short Hair
What is your pet's breed or physical description:
How long have you had your pet?:
If your pet is female, click all that apply in the choices below. If none, click, “none.”
She is in heat now
She is pregnant now
She has been pregnant in the past
She has had a, “C Section”
None of the above If your pet is female, when was the last time she was in heat?:
Does your pet have a current rabies vaccine?
YES
NO
What is the date of your pet's rabies vaccine?:
What is the brand of heartworm preventative you give your pet?:
Has your pet had any previous surgeries?
YES
NO
If your pet has had any previous surgeries, please list the reason for the surgery/surgeries and the date(s):
I acknowledge that the clinic performing the surgery and St. Seton's Orphaned Animals are not responsible for any post operative complications where the pet guardian has not followed the post operative instructions
YES
NO
Saint Setont's Orphaned Animals, spay, neuter, financial assistance, low cost, no cost, Culpeper, VA.
