Petstablished | Manage your Animal Welfare Organization (AWO) with our easy-to-use software.

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Personal Information

* First name

* Last name

* Email

* Email confirmation

Home phone

Cell number

* Current Address

Current Address 2

* Zip

* City

Country

*State/Province

Date of Birth

* Month

* Day

* Year

Pet Information

We will be filling spots for the clinic first with qualifying pets from low-income families, but there will also be spots available for those who do not qualify for assistance. The following questions help us identify if you qualify for assistance. Thank you.

Please list all of the animals that you are requesting assistance for. Include all of the following information: name, species, predominant breed, gender, coat color, and approximate date of birth. If you are requesting assistance for a dog, please provide a weight for your dog.

Please note that not providing all of the above information for each of your pets can significantly delay the process of scheduling an appointment.

Example: Buttercup, cat, domestic shorthair, female, orange tabby, 3/1/2020. Jake, dog, pit bull mix, male, tan and white, 3 years old, 65 pounds.

Does your pet (or pets) have any diagnosed health conditions? (i.e. seizure conditions, prior difficulties with anesthesia, previous reactions to vaccines etc.)

The following treatments are included with your pet's spay/neuter surgery: Rabies vaccine, distemper vaccine, nail trim, and ear cleaning. Flea treatment is included for cats and can be provided to dogs for an additional $15.

Please indicate below if you do NOT want your pet to receive any or all of the additional treatments. Please note that you will have to provide a current rabies certificate at the time of your pet's appointment if you decline a rabies vaccine. If this information is not provided, per rabies law, your pet will receive a rabies vaccination during the time of surgery.

If your pet is timid or reactive to strangers or other animals, please indicate that below. The more details you provide will help us schedule and care for your pet with minimal stress on him/her.

Financial Information

Similar to the Pet Information, these questions are to help us ascertain the best way we can assist you and to find out whether you qualify for financial assistance.

Please pick the choice that most accurately reflects your household annual income.

1 person - $20,120 annually or less2 people - $27,214 annually or less3 people - $34,307 annually or less4 people - $41,400 annually or less5 people - $48,493 annually or less6 people - $55,586 annually or less7 people - $62,680 annually or less8 people - $69,773 annually or lessNone of these describe my household (Please explain in the comments below)

Do you receive assistance from any of the following programs? (Please check all that apply)

Food stampsSupplemental Security Income (SSI)Temporary Assistance for Needy Families (TANF)Social Security Disability (SSD)MaineCareNone of the above

Please attach a file or photo showing that you receive state assistance from one of the above programs OR a file/photo that verifies your income status (only one document needs to be provided)

Comments

I have read and agree to the terms and conditions. By checking this box I am confirming that I am 13 years of age or older.

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Spay/Neuter Clinic

Personal Information

Pet Information

Financial Information