Homepage Fill Out Your Spay Neuter Coupon Form
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The Spay Neuter Coupon form serves as a vital resource for pet owners seeking affordable options for spaying and neutering their animals while promoting responsible pet ownership. Designed for single animal use, it collects essential details about both the owner and the pet, including names, contact information, and specifics about the animal, such as the species and gender. The form emphasizes understanding and acceptance of the terms associated with the Spay Neuter Assistance Program, Inc. This includes a release of liability, ensuring that the organization is not held responsible for any claims arising from the procedure. The process is straightforward: after completing the form, pet owners are instructed to select a participating veterinary practice from the provided list, schedule an appointment, and present the coupon along with any required vaccination certificates. The form also outlines clearly the costs associated with the surgeries, distinguishing between male and female pets, as well as outlining additional potential charges that may arise depending on each veterinary practice's policies. By clarifying what is included in the program and the process to follow, this form aims to make spaying and neutering accessible and manageable for all pet owners in South Central Pennsylvania.

Spay Neuter Coupon Example

SPAY NEUTER COUPON -- PLEASE PRINT OR TYPE --

SPAY NEUTER ASSISTANCE PROGRAM, INC.

P.O. BOX 126702

HARRISBURG, PA 17112-6702

(717)732-LESS (5377) www.snapofpa.org

Serving South Central Pennsylvania

SECTION 1 OWNER & ANIMAL INFORMATION ** ONLY ONE ANIMAL PER FORM **

Owner's Name

Street

City

 

 

 

 

 

 

 

 

 

 

 

 

State

 

 

 

 

Zip

 

Phone No. Daytime

 

 

 

 

 

 

 

Evening

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pet's Name

 

 

 

Cat Male

 

 

 

 

Dog Male

 

 

 

 

 

Pet's Age

 

 

 

 

Female

 

 

 

 

Female

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I (we) hereby agree(s) to at all times release and hold harmless Spay Neuter Assistance Program, Inc., its oficers, directors, members, agents and assigns from and against any and all claims, liabilities, losses,

damages, charges, fees and expenses of every nature and character which I (we) may sustain or incur by reason or on account of the spaying or neutering of my (our) animal(s) described above. I (we) understand that the Spay Neuter Assistance Program's only involvement and purpose is to provide funds (with or without contributions from animal owners) for the spaying and neutering of domestic animals. Accordingly, I (we) hereby issue this release from liability. I (we) further agree to execute whatever documents are required by the Doctor(s) of Veterinary Medicine who are to perform the spaying and neutering on my (our) pet.

DateSignature

(Must be at least 18 years of age)

Instructions:

1. Complete Section 1 including signature and date.

2.Select a veterinary practice from the list on back and call THEM to schedule your appointment.

3.Specify that you are using a Spay Neuter Assistance Program Coupon.

4.This coupon as well as all certiicates for required vaccinations must be presented at the time your pet is admitted to the veterinary practice for surgery.

5. The entire cost for surgery is due at the time of service.

The Veterinary Practices listed on the back of this form participate in SNAP's low-cost

program and honor the SURGERY rates shown below.

ADDITIONAL CHARGES MAY BE IMPOSED AT THE DISCRETION OF EACH PRACTICE

y also schedu

and are your inancial responsibility.

 

 

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y also scheduMale Cats -

$25 (Surgery Fee Only)

y also scheduMale Dogs - (0-80 lbs) - $55

(Surgery Fee Only)

 

 

Female Cats -

$40 (Surgery Fee Only)

 

 

Female Dogs - (0-80 lbs) - $65

(Surgery Fee Only)

 

 

 

 

 

 

80 lbs. - Fee varies by veterinary practice

 

 

 

 

 

 

 

 

LOW COST SPAY NEUTER PROGRAM PARTNER

Humane Society of Harrisburg Area

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Hu

NO

The participating veterinary practices listed below establish their own guidelines for acceptance of SNAP

Spay Neuter Coupons & Grants. A preliminary ofice visit, proof of current vaccinations, blood work, overnight stay, and/or additional vaccinations/shots, may be required. Fees for surgical complications, females in heat or pregnant, or males with undescended testicles may also be applied. These and any other

costs will be charged at the Veterinarians’ discretion, at their rates, and are in addition to the surgery price indicated on this form. Any and all of these ancillary charges are your inancial responsibility.

It is recommended that you obtain an estimate of costs and understand all conditions, prices, and requirements prior to selecting a practice and scheduling your pet for surgery.

In some cases, a deposit is mandatory to secure your appointment.

Age restrictions vary by practice.

When calling to schedule your pet for surgery, identify yourself as a SNAP Client. Failure to do so will result in standard ofice rates being charged.

CUMBERLAND COUNTY

DAUPHIN COUNTY

Newville Animal Hospital

Colonial Park Animal Clinic

Newville 776-6311

Harrisburg 540-7140

(Cats Only)

 

 

Noah's Ark Veterinary Center

Holly Pike Animal Hospital

Harrisburg 652-5923

Carlisle 240-0700

 

(Cats Only)

LEBANON COUNTY

Gettysburg Road Animal Hospital

Palmyra Animal Clinic

Mechanicsburg 697-7373

Palmyra 838-5451

Silver Springs Animal Clinic

Pet's Day Surgery

Mechanicsburg 766-5980

Lebanon 675-2080

Boiling Springs Animal Hospital

East Lebanon Animal Clinic

Boiling Springs 258-4575

Lebanon 272-2453

The low cost for Spaying / Neutering your pet is made possible thanks to the donation of time and supply costs by our participating veterinarians.

Please show your appreciation for the important community service they provide

by keeping your appointment.

THIS COUPON HAS NO MONETARY VALUE.

It will only guarantee the reduced cost spay neuter surgery prices as shown

at the participating veterinarians listed above.

NO COUPON NEEDED

 

To schedule an appointment, please call 564-3320 and follow the prompts. Leave your name, phone number,

 

desired clinic day, and whether the cat or dog needs to be spayed (female) or neutered (male).

 

You may also schedule an appointment by emailing Kristy Shelly at kristys@humanesocietyhbg.org.

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y also scheduMale Cats -

$40 (No Additional Charges)

y also scheduMale Dogs - $70

(No Additional Charges)

 

 

Female Cats - $60 (No Additional Charges)

 

 

Female Dogs - $85

(No Additional Charges)

Cats and dogs should be a minimum of 4-5 months of age and younger than 7 years and must be up-to-date on vaccinations. Proof of current vaccinations (rabies and distemper combination) must be provided. If proof of vaccination is not provided, vaccines will be administered by HSHA for an additional $10 each.

SECTION 2 FOR SNAP VETERINARIAN USE ONLY

The animal described above on

had the following Veterinary procedure performed Fee $

(Veterinary Hospital)

(Signature of Veterinarian)

SECTION 3 FOR SNAP USE ONLY

Grant #

Date Approved

Amount from Client

Amount from SNAP

Total

Pd. Ch. #

 

Date

PLEASE READ BOTH

PLEASE READ BOTH

SNC 05/13 SIDES CAREFULLY

SIDES CAREFULLY

SNC 05/13

Form Characteristics

Fact Name Fact Detail
Purpose of the Coupon This coupon facilitates reduced-cost spay/neuter surgeries for domestic pets.
Eligibility Pet owners can only submit the coupon for one animal per form.
Owner’s Agreement By signing, the owner releases Spay Neuter Assistance Program, Inc. from liability related to the procedure.
Vaccination Proof Proof of current vaccinations (rabies and distemper) must be presented for the pet.
Usage Instructions Owners must call a participating veterinary practice to schedule and specify their coupon use.
Cost Structure Fees for surgery vary by animal type and weight; typical male cat fees start at $25.
Geographical Application The coupon is valid in South Central Pennsylvania, including counties such as Cumberland and Dauphin.
Additional Charges Veterinary practices may impose extra fees based on the individual needs of the pet.
Minimum Age Requirement Pets should ideally be at least 4-5 months old for safe spay/neuter procedures.
Donation Contribution The program relies on donations of time and supplies from participating veterinarians to keep costs low.

Guidelines on Utilizing Spay Neuter Coupon

Filling out the Spay Neuter Coupon form requires attention to detail to ensure accuracy. Following these steps will help simplify the process and ensure the necessary information is provided correctly. After completing the form, the next action involves scheduling an appointment with a participating veterinary practice while understanding the associated costs for the procedure.

  1. Begin by entering the owner's name in the space provided at the top of the form.
  2. Add the street address, city, state, and zip code of the owner.
  3. Provide the owner's phone number. Include both daytime and evening contact numbers if available.
  4. Fill in the pet's name as well as the species (cat or dog) and gender.
  5. Indicate the pet's age in the designated area.
  6. Read the release of liability statement carefully. By signing, the owner agrees to hold the Spay Neuter Assistance Program harmless.
  7. Date the form and provide a signature. Ensure the signer is at least 18 years of age.

After submitting the form to the appropriate veterinary practice, be prepared to present the coupon and any required vaccination certificates at the time of the appointment. The cost of the surgery must be paid in full on the day of the procedure.

What You Should Know About This Form

What is the purpose of the Spay Neuter Coupon form?

The Spay Neuter Coupon form is designed to assist pet owners in receiving low-cost spaying or neutering services for their animals. This program aims to make these essential veterinary procedures more accessible, thereby helping to control the pet population in South Central Pennsylvania. By using this form, pet owners can guarantee reduced surgery costs at participating veterinary practices, ensuring their pets receive necessary care without financial burden.

How do I complete the Spay Neuter Coupon form?

To fill out the Spay Neuter Coupon form, begin by providing your personal information and details about your pet in Section 1. This includes your name, address, phone number, and your pet's name and gender. After signing and dating the form, you need to call a veterinary practice from the provided list to schedule an appointment. It’s important to inform the veterinary office that you will be using a Spay Neuter Assistance Program Coupon at the time of your visit.

What might additional costs be during the procedure?

While the coupon covers the basic costs of spaying or neutering, various factors might lead to additional charges. These could include preliminary office visits, required vaccinations, blood work, and any unexpected surgical complications. Fees associated with pets in heat or pregnant, as well as for males with undescended testicles, may also apply. It’s advisable to discuss any potential costs with your chosen practice before your appointment.

Are there age restrictions for pets undergoing surgery?

Yes, age restrictions can vary by practice, but generally, pets should be a minimum of 4-5 months old and younger than 7 years to qualify for the surgery. Additionally, your pet must be up-to-date on vaccinations. If you cannot provide proof, the veterinary clinic may require that additional vaccines be administered at a charge.

What should I do if I have questions about the Spay Neuter Coupon program?

If you have any queries concerning the Spay Neuter Coupon program or its procedures, you can reach out to the Spay Neuter Assistance Program directly at the contact number (717) 732-LESS (5377). Additionally, you can visit their website at www.snapofpa.org for more information, FAQs, and resources related to the program.

Common mistakes

When filling out the Spay Neuter Coupon form, many individuals make mistakes that can delay or complicate the process. Understanding these common errors can save you time and ensure your pet receives the care it needs.

One frequent mistake is leaving out essential information. Each section of the form is critical. For example, if the owner's name or contact details are missing, it creates confusion and may lead to a rejected application. Always double-check to ensure all fields are filled-in accurately.

Another common error involves the pet's details. Some people mistakenly write down the wrong type of animal or specify incorrect gender. Ensure that you clearly indicate whether the pet is a male or female cat or dog. An accurate description helps veterinary staff prepare for the procedure appropriately.

Many applicants fail to sign the form. A missing signature invalidates the entire application. Remember that this form constitutes a legal agreement, and without a signature, the release of liability cannot be honored. Always sign and date the form to confirm your understanding and acceptance of the terms.

Another issue arises when individuals forget to specify that they are using a Spay Neuter Assistance Program coupon when scheduling an appointment. If you neglect to mention this, the veterinary practice may charge standard rates rather than the reduced ones specified. Always communicate clearly during this initial contact.

Some people overlook the instructions regarding vaccination records. If the required proof of current vaccinations is not included at the appointment, additional fees may be incurred. Always gather and provide these records to avoid unexpected costs.

It is also crucial not to assume that all practices have the same guidelines. Each participating veterinary practice sets its own rules regarding acceptance of coupons. Each practice may require an office visit or additional vaccinations, which could result in extra charges. Familiarize yourself with the policies of your chosen practice.

Finally, not reading the disclaimer can lead to misunderstandings. The coupon has no monetary value and merely guarantees reduced surgery prices. It is vital to understand that this coupon's usage is limited and must be presented correctly at the time of service.

Documents used along the form

The Spay Neuter Coupon form is an essential document for pet owners seeking low-cost spaying and neutering services. When submitting this form, several other documents may be required to ensure a smooth process. Below is a list of documents commonly used alongside the Spay Neuter Coupon form.

  • Proof of Vaccination: Most veterinary practices require proof that pets are current on vaccinations, particularly rabies and distemper, prior to surgery. This document may include vaccination certificates from the owner's veterinarian.
  • Release of Liability Form: A document that pet owners sign to acknowledge the risks involved with spaying or neutering their pets. This form protects the veterinary practice from potential claims.
  • Pet History Form: Some veterinarians may ask for a form detailing the pet’s medical history, including past treatments or known health issues. This helps the veterinarian assess the health of the pet before surgery.
  • Appointment Scheduling Form: Although not always required, some veterinary offices use this form to collect information needed to schedule an appointment for the procedure and confirm details with the pet owner.
  • Pet Owner Agreement: This document outlines the responsibilities of the pet owner regarding the care of the pet before and after the procedure. It may also include instructions for post-operative care.
  • Proof of Income (if applicable): For programs offering financial assistance, pet owners might need to provide proof of income to determine eligibility for discounts on the spaying/neutering services.
  • Special Needs Authorization Form: If the pet has any special needs that the veterinarian should be aware of, this authorization allows the owner to provide detailed information and receive appropriate care.
  • Emergency Contact Form: A form that includes contact information for someone who can be reached in case of an emergency during the procedure, ensuring the pet’s safety and prompt communication.

When preparing for a spaying or neutering appointment, it is vital to have these documents ready. They ensure that the veterinary practice has all the necessary information to provide care and support for the pet during this important procedure.

Similar forms

  • Vouchers for Medical Services: Similar to the Spay Neuter Coupon, medical service vouchers provide financial assistance for healthcare services. They outline the specific services covered, often require the patient to confirm their appointment beforehand, and may include terms of use that clarify the responsibilities of both the service provider and the recipient.

  • Discount Pharmacy Coupons: These coupons offer reduced prices on prescription medications. Much like the Spay Neuter Coupon, they necessitate presentation upon purchase and can only be applied at participating pharmacies. Conditions may also apply, requiring users to meet particular eligibility criteria.

  • Food Assistance Program Applications: Applications for food assistance require personal information and household details. They are similar to the Spay Neuter form in that they often need to be filled out and submitted prior to receiving benefits. Verification steps may exist to ensure eligibility, just as in the spay/neuter program.

  • Pet Adoption Applications: When adopting a pet, prospective owners must complete an application that includes information about themselves and their willingness to care for an animal. Like the Spay Neuter Coupon, these applications aim to ensure that the recipient is prepared to offer a suitable environment for the animal.

  • Insurance Claim Forms: Just as the Spay Neuter Coupon requires dog or cat owners to submit information in advance, insurance claim forms demand detailed descriptions of services received, along with the patient’s information and a signature. Both documents aim to streamline the process of receiving financial support for necessary services.

  • Discounted Membership Applications: Many organizations offer discounted rates for membership based on income. Similar to the Spay Neuter Coupon, these applications require personal details and may also involve agreements to utilize services in a certain manner, aiming to enhance community accessibility.

Dos and Don'ts

When filling out the Spay Neuter Coupon form, it is essential to be meticulous to ensure a smooth process. Below are important guidelines to consider:

  • Do: Print or type your information clearly to avoid misunderstandings.
  • Do: Fill out only one animal per form as instructed.
  • Do: Ensure that you provide accurate contact information for any follow-up communication.
  • Do: Schedule your appointment with a participating veterinarian listed on the back of the form.
  • Do: Present the coupon and proof of vaccinations at the time of admission for surgery.
  • Do: Confirm all associated costs beforehand, including any additional charges that may apply.
  • Do: Sign and date the form, ensuring that the signer is at least 18 years of age.
  • Don't: Misinterpret the requirement for one animal per form; submitting multiple animals could lead to delays.
  • Don't: Forget to call the veterinary practice to schedule your appointment and mention that you are a SNAP client.
  • Don't: Ignore any peculiar requirements of the veterinarian, such as preliminary office visits or vaccination proofs.
  • Don't: Assume that additional costs will not arise. Always ask about potential fees upfront.
  • Don't: Submit the form without checking for completeness and accuracy.
  • Don't: Fail to provide updated vaccination records, as this could incur additional expenses.
  • Don't: Delay your appointment confirmation; a prompt response is appreciated and often required.

Misconceptions

Misconception 1: The Spay Neuter Coupon can be used for multiple pets.

This is incorrect. Each Spay Neuter Coupon form is designated for only one animal per form. Therefore, pet owners must complete separate forms for each animal they wish to have spayed or neutered.

Misconception 2: The coupon covers all veterinary costs associated with surgery.

In reality, the Spay Neuter Assistance Program only guarantees the reduced surgery cost listed. Additional charges may apply based on the specific veterinary practice and any necessary services such as office visits, vaccinations, or complications during the procedure. Pet owners are responsible for these extra costs.

Misconception 3: Any veterinary practice will accept the Spay Neuter Coupon without prior arrangement.

This is not true. Pet owners must select a participating veterinary practice from a designated list and call to schedule an appointment. It is crucial to inform the practice that the appointment will use a Spay Neuter Assistance Program Coupon to avoid being charged standard office rates.

Misconception 4: All animals can be spayed or neutered, regardless of age or health status.

Age and health restrictions do apply. Pets should generally be between 4-5 months and younger than 7 years of age, and they must be up-to-date on vaccinations. If these conditions are not met, surgeries may not be performed, or additional services may be required.

Key takeaways

Filling out the Spay Neuter Coupon form is straightforward, but attention to detail will ensure a smooth process.

  • One Animal Per Form: Each coupon is designated for a single animal. Make sure to fill out separate forms for multiple pets.
  • Provide Accurate Information: Carefully complete the owner's name, address, and contact details to avoid any communication issues.
  • Signature Required: Ensure the form is signed and dated, as this validates your agreement and permission.
  • Choose a Participating Veterinary Practice: Review the list provided and call the clinic of your choice. It’s important to mention that you are using a SNAP coupon when scheduling your appointment.
  • Cost of Surgery: Be prepared to pay the full amount due at the time of service. Keep in mind that additional charges may apply depending on your pet’s condition.
  • Bring Required Documents: Present the coupon along with any necessary vaccination certificates upon your pet’s admission to the veterinary practice.
  • Understand Additional Charges: Ask your chosen clinic about potential extra costs that could arise, such as those for pre-surgery exams or complications.
  • Keep Your Appointment: It’s crucial to honor your scheduled time. Appreciate the veterinarians’ services, as they provide an essential function within the community.

Being informed and prepared will make the spay/neuter process much easier for both you and your pet. Enjoy the peace of mind that comes with helping control the pet population!