Application for Low Cost Spay/Neuter Program

Fayetteville Animal Services Clinic
340 Armstrong Avenue
Fayetteville, AR 72701
479-444-3456

Requirements

- You will need to submit a copy of your driver's license and proof of income (check stub, bank statement, benefits statement, etc.) with your application.
- There is $25 flat fee for the spay/neuter program. The program fee covers the surgery, microchip and rabies vaccination as well as an optional, FVRCP, parvo/distemper and/or bordetella booster.
- Microchips are not optional.
- All cats must be brought in and picked up in a carrier for surgery.
- If your pet is in need of grooming for health reasons, you WILL be charged for this service.
- Animals with live fleas/ticks will be treated for an additional cost of $5 per animal.

Applicant Information

Name*field type single line
Input blocked. Maximum character limit of 60 characters reached.
Date of Birth*field type date
mm/dd/yyyy
Address*field type address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Home/Cell Phone*field type single line
Input blocked. Maximum character limit of 25 characters reached.
Work/Other Phonefield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Email Address*field type single line
Input blocked. Maximum character limit of 50 characters reached.
Driver's License Number*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Driver's License State*field type drop-down
How many adults are in your household?*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
How many children are in your household?*field type single line
Input blocked. Maximum character limit of 4000 characters reached.

Pet Information

×
- Name*field type single line
  Input blocked. Maximum character limit of 4000 characters reached.
- Species*field type radio button
  SpeciesDogCat
- Sex*field type radio button
  SexMaleFemale
- Breed*field type single line
  Input blocked. Maximum character limit of 4000 characters reached.
- Color*field type single line
  Input blocked. Maximum character limit of 4000 characters reached.
- Age*field type single line
  Input blocked. Maximum character limit of 4000 characters reached.
- Weight*field type single line
  Input blocked. Maximum character limit of 4000 characters reached.
- Has the animal been vaccinated in the past 12 months?*field type radio button
  Has the animal been vaccinated in the past 12 months?YesNo
- When?*field type single line
  Input blocked. Maximum character limit of 4000 characters reached.
- Do you have a veterinarian?*field type radio button
  Do you have a veterinarian?YesNo
- Veterinarian Clinic Name*field type single line
  Input blocked. Maximum character limit of 4000 characters reached.
- Veterinary Clinic Phone Number*field type single line
  Input blocked. Maximum character limit of 4000 characters reached.
Add Additional Pet

Document Upload

Driver's License*field type file upload
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Proof of Income*field type file upload
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Check stub, bank statement, benefits statement, etc.

Signature

I swear/affirm that these answers are true and correct to the best of my knowledge.
Signature*field type signature
Date*field type date