NEW - Cape Breton Animal Hospital Public Spay & Neuter Application Step 1 of 3 33% CONTACT INFORMATIONName* First Last Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Phone*Alternate Contact Number*Email* Enter Email Confirm Email How did you hear about our Spay & Neuter Services?Have you applied to us before?*NoYes ANIMAL INFORMATIONFirst Animal Information*CatDogGenderMaleFemaleI don't knowAge?*In yearsColour/DescriptionSecond Animal InformationCatDogGenderMaleFemaleI don't knowAge?*In yearsColour/Description?Is your animal(s) on any medications?*YesNoIf yes, please list medications and reasons for taking them...Is your pet showing any of these symptoms: vomitting, rash or diarrhea?*YesNoHow did you get your pet?* Stray Breeder Kijiji Rescue Group Other Do you currently have a vet?*YesNoIf yes, what is the name of your Vet Clinic?Is this a TNR? (if yes, please note there are additional fees and outpatient instructions for TNR services)*YesNoSee for more information on what TNR means visit: http://spcans.ca/spca-vet-services/trap-neuter-return/ FINANCIAL INFORMATIONAre you on Public Assistance?*YesNoDo you receive Disability or Unemployment?*YesNoPlease list the TOTAL annual income of your household*Total combined income in $$How many adults live in this household?*18 years and olderHow many children live in this household? (under 18 years old)*CONSENT (click on text below to agree to the statement)* Yes - by submitting this form I hereby cerifty that the information i have provided is truthful and correct to the best of my knowledge. I hereby agree to waive any and all claims for damages against the Nova Scotia SPCA, and any officers, volunteers, or agents of the program in the event of death or injury to the animal during surgery. I also consent to the SPCA contacting me regarding this application.