Best Friends of Pets Spay Neuter Assistance Program APPLICATION AND VOUCHER

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Buddy Cain
5 years ago
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Best Friends of Pets Spay Neuter Assistance Program PO Box 14547 Oklahoma City, OK 73113-0547 (405) 418-8511 Office: 720 W. Wilshire Blvd.

3 Best Friends of Pets Spay Neuter Assistance Program PO Box Oklahoma City, OK (405) Office: 720 W. Wilshire Blvd., Suite 101-F, Oklahoma City APPLICATION AND VOUCHER INSTRUCTIONS FOR PET PARENTS FOR VETERINARY CLINICS / HOSPITALS You must be approved before this surgery Applications must be pre-approved by administrator Send proof of benefits or income -0- Initials - rabies vaccination not paid by pet parent Include payment with application Expiration date is shown in Part 2 Check or money order payable to Best Friends of Pets Return this copy with monthly invoice PART 1 YOUR INFORMATION LAST NAME, YOUR FIRST NAME PLEASE PRINT. USE BLACK OR BLUE INK. TELEPHONE NUMBER MAILING ADDRESS CITY ZIP CODE HOW ARE YOU QUALIFYING FOR ASSISTANCE? SoonerCare / OKDHS / SSI * Low-Income # General Public # * SEND PROOF OF BENEFITS # SEND PROOF OF INCOME. FAMILY SIZE (a copy of Benefits Card or Letter) # Include gross income for all members earning income PET INFORMATION Male Cat Female Cat Male Dog Female Dog NAME OF PET (One Per Application) BREED (Dog if known) or COLOR APPROX. WEIGHT (Dog) APPROX. AGE INCLUDE CHECK OR MONEY ORDER PAYABLE TO BEST FRIENDS OF PETS FOR TOTAL FEES DUE. Low-Income General Public Cat/Dog Special $10 Cat $20 Dog $35 Male Cat $60 Female Cat Amount Paid $70 Male Dog $90 Female Dog $ All Applicants $5 Cat or Dog 12 weeks or older (if rabies vaccination is required). You must present a valid rabies certificate to the veterinarian to avoid the rabies vaccination. If no proof is presented and payment is not included with this application, you are responsible for total payment of the rabies vaccination. How did you hear about Best Friends of Pets Spay Neuter Assistance Program? Friend/Family Flier/Brochure Internet Facebook Animal Shelter Social Services Used Before Other Location or name of item checked I CONSENT TO THE SPAYING OR NEUTERING AND RABIES VACCINATION, IF REQUIRED, OF THE PET DESCRIBED ABOVE. THE ABOVE INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. SIGNATURE OF PET PARENT DATE PART 2 FOR BEST FRIENDS OF PETS USE ONLY SIGNATURE OF BEST FRIENDS OF PETS SPAY NEUTER ADMINISTRATOR DATE EXPIRATION DATE OF SPAY NEUTER VOUCHER PART 3 VETERINARY INFORMATION (TO BE COMPLETED BY VETERINARY CLINIC / HOSPITAL) CLINIC / HOSPITAL NAME PHONE NUMBER DATE SPAYED / NEUTERED / RABIES VACCINATION SIGNATURE OF VETERINARIAN / CLINIC ADMINISTRATOR

4 See Notes, page 2 BEST FRIENDS OF PETS - Spay Neuter Assistance Program Participating Veterinary Clinics by Location Location or Closest Major Intersection Clinic Phone Number NW 39th & Council Bethany Animal Hospital $ w 2# 12w 50# NW 23rd & Council Council Veterinary Hospital $ # 3# 75# NW 46th & Classen Pet Friends Veterinary Hospital $ w 2# 8w 2# 50# Britton & Rockwell Rockwell Pet Clinic w 5m 40# NW 43rd & MacArthur Warr Acres Animal Clinic w 12w SW 57th & Penn Animal Wellness Center of OKC $ w 2# 8w 2# 8y 8y 135th & S. Western Boyer Veterinary Clinic ** w 2# 8w 2# 15# 85# SE 44th & Sunnylane Oakwood Veterinary Clinic ** m 6m 60th & S. Western OK Humane Place Spay/Neuter Clinic $ w 2# 8w 2# 85th & S. Western South Western Pet Clinic w 3# 16w 3# 7y 7y 65# Blanchard Blanchard Animal Hospital ** w 12w 6y 6y Choctaw Town and Country Animal Hospital $ ** m 3# 5m 3# 10y 10y Del City Wellington Parke Animal Clinic $ w 2.5# 8w 2.5# 10y 10y 100# Edmond Feline Medicine & Surgery ** m 4# 1y 10# El Reno 4V Animal Clinic ** m 3m Meeker Meeker Animal Hospital w 2# 4m 2# 7y 12# 5y 60# Midwest City Midwest Veterinary Hospital m 6m Midwest City Post Road Pet Clinic m 6m Moore SpayXperts $ w 2# 12w 2# 18# 80# Mustang Mustang Animal Health Clinic m 6m 6y 6y 100# Noble Noble Animal Clinic $ m n/a 4m n/a 100# 7/24/2018

5 See Notes, page 2 BEST FRIENDS OF PETS - Spay Neuter Assistance Program Participating Veterinary Clinics by Location Location or Closest Major Intersection Clinic Phone Number Norman Only Veterinary Clinic # n/a n/a n/a n/a Norman Main Street Veterinary m 3# 3m 3# Norman University Animal Hospital m 5m Shawnee Angels for Animals $ w 2# 8w 2# 10y 10y Shawnee Best Friends Animal Clinic (not a part of Best Friends of Pets) $ w 2.5# 8w 2.5# 10y 10y 100# Wanette Cedar Creek Veterinary Clinic $ w n/a 6-12w n/a n/a n/a n/a n/a Yukon Yukon Pet Care Clinic m 6m 100# NOTES $ Discounted annual vaccinations available ** Qualified low-income applicants only + Pet owner may incur additional fees (i.e., post-op pain medications, flea control, surgery complications, etc.) +! Pain medications required. Pet owner may incur additional Annual vaccinations required. Call clinic to see if these are required in advance or can be done the day of the surgery. blank Veterinary clinic did not indicate any minimums or maximums 7/24/2018

Top Dog Foundation Bentley Veterinary Care Gran t Program

Top Dog Foundation Bentley Veterinary Care Gran t Program Step One Do you qualify? Step Two Have you applied for Care Credit, if your veterinarian accepts Care Credit? Step Three Application/Copies of Documentation Step Four Veterinarian Information and Estimate