Atlantic County S.P.C.A.
PO Box 205
Somers Point, NJ 08244
 

Page 1 of 4

SPAY NEUTER FORM New or Current Patient

Invalid Input
Invalid Input
   For your Information: Regarding spay/neuter applications, we only screen new clients for financial need if your pet is a DOG. The cat spay/neuter clinic is a separate program and doesn't require screening whether you are a new client or not. Thank you.   
You answered "yes" that you are a new client. Before you submit this form, we need to ask you just a few more questions.   **For your information: Regarding spay/neuter applications, we only screen new clients for financial need if your pet is a DOG. The cat spay/neuter clinic is a separate program and doesn't require financial need screening whether you are a new client or not. Thank you!
I am applying to become a client and receive veterinary services for my pet(s) at the Atlantic County SPCA low-cost clinic. I understand that the Atlantic County SPCA's mission is to provide low-cost care to underprivileged pet owners, in an effort to reduce financial euthanasia and the surrendering of pets to animalshelters due to a lack of financial means and can present proof that I receive one or more of the following (please upload your document at the end of this application):.
I certify that I am in need of this CHARITY CARE, and can present proof that I receive one or more of the following: Food Stamps, Medicaid (NJ Family Care), General Public Assistance, Rental Assistance, Aid to Families with Dependent Children, Lifeline Utility Credit, Tenants' Lifeline Assistance, Supplemental Security Income (SSI), Pharmaceutical Assistance to the Aged & Disabled--PLEASE UPLOAD YOUR DOCUMENT AT THE END OF THIS APPLICATION.
Invalid Input
OR
 
I received none of the above. However, I'd like to continue my application because:
I have been declined by 3rd party financing (ie. Care Credit) through my regular veterinarian. (I will provide documentation.)
Invalid Input
OR,
I have been affected negatively by the Covid-19 pandemic in the following way(s):

0/500

Invalid Input
OR,
Other Reason:

0/500

Invalid Input
Please type your full name.
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid email address.
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input



Invalid Input



Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
I, the undersigned, understand that I am participating in a low cost spay/neuter service for my pet through the Atlantic County S.P.C.A. (ACSPCA) and that my pet will be going under general anesthesia for elective surgery. I understand that pre-anesthetic blood testing is available to me prior to surgery, either through the ACSPCA or through my regular veterinarian. I have been explained the benefits of pre-anesthetic blood testing, and I have made the decision to (check one): □ elect basic testing (done the morning of surgery, at an additional cost of $40 + $15 if my dog has not had a heartworm test in the last 12 months) or □ decline any and all testing. Further, I understand that, even when all possible precautions are taken, anesthesia and surgery carry inherent risks and that, rarely, these risks can even result in death. I do not hold the ACSPCA or any of its veterinarians, employees, or volunteers liable for damages that occur during anesthesia, as it carries inherent risks.
Cat Spay/Neuter Clinic Only:  I understand that all cats presented to the ACSPCA Veterinary Clinic for spay or neuter services are checked for the presence of fleas and ear mites. I agree that if either of these parasites are detected on my cat, he or she will automatically be treated during anesthesia. I understand that at least one (1) dose of topical Selarid is required to treat fleas, and two (2) doses (2 weeks apart) are required to treat ear mites. If these treatments are deemed necessary, I agree to pay the additional fees at a cost of $12 per Selarid dose. Further, if tapeworm segments are detected on my cat, I understand that he or she will automatically be administered an injectable medication (praziquantel) to treat this, at a cost of $25. Any additional necessary medications or treatments will be at the discretion of the veterinarian, and a cost estimate will be provided. I understand that any recommended additional treatments may or may not incur an office visit fee of $25, at the discretion of the ACSPCA Veterinary Clinic. In addition, I agree that any cats found to have an umbilical hernia, or any male cats found to be cryptorchid (retained testicle), will automatically receive any additional necessary surgery, which will add a fee of $25-50 over and above my final invoice. I understand that no flea, ear mite, or tapeworm treatments will be performed unless these parasites are detected on the day of the procedure. Considering the unpredictable nature of the above, I agree to have an additional $50-100 available to pay my invoice during discharge/pickup, in the case that fleas, ear mites, tapeworms, umbilical hernias, and/or retained testicles are discovered. I also understand the the ACSPCA Veterinary Clinic requires that each cat arrive in its own, individual pet carrier, and that carriers containing more than one animal are not acceptable. I agree that this rule exists for the safety and well-being of my pet(s) and the clinic staff. I understand that if I do not bring the correct number of carriers, I will be asked to leave a $30 deposit in order to borrow a carrier from the ACSPCA (if one is available), which will need to be paid during morning drop-off. If no extra carriers are available to borrow, I will be asked to leave and immediately return with the correct number of carriers (there is a PetSmart approximately 3 miles away, in Somers Point).
Invalid Input
Invalid Input
Invalid Input
Atlantic County SPCA

Location


Implementation, hosting and maintenance by Joomla Connections, LLC
Copyright © 2022 Atlantic County Society for the Prevention of Cruelty to Animals. All Rights Reserved.
Joomla! is Free Software released under the GNU General Public License.