Waiting List Form for Residents of Independence County
Information sheet to be placed on the waiting list. ALL questions must be answered. You MUST send text a picture of your animal, with their name, along with something showing your physical address (driver's license, utility bill) to 8702300272. You will not be placed on the list until this form is received AND the photos mentioned above. If you have more than one animal, you'll fill out the same form for each one. 
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Why did you choose us as a spay neuter option vs another local vet clinic? (Feedback for us only and for more grants!) *
LAST name, FIRST name (PLEASE use this format) *
Your Physical Address (NO Post Office Boxes. You MUST send something to verify this address and your Independence County resident [driver's license, utility bill, etc])  *
Your Phone Number *
Your Email *
Household Income (stats for grant funding) *
Name of Animal?  *
Species and Sex of Animal?  *
Is there any chance the Animal could be pregnant? (Helps with planning) *
Estimated weight of Animal?  *
Date of Birth or Estimated Age of Animal?  *
Does Animal have any special markings, etc for identification? If not, put NA *
Does Animal need a RABIES vaccine? (If not, that saves us $$, but, you must text a certificate from a licensed vet.) *
Do you want vaccines for Animal? These are $38.40 and must be paid when dropped off (we cannot cover this cost). *
Are there any issues on Animal of which we should be aware? *
Do you have a hard crate, not metal, that can be used for transport of Animal? *
When will you drop off Animal?  *
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