Spay Neuter Form - Gone to the Dogs Rescue

I need the following information from owners. This info will not be uploaded to the clinic, it is for my use only.

Owner’s name:

Owner’s address:

Owner’s cell phone number:

Owner’s email address:

Name and number of someone who can reliably reach you if the info above is not reliable:

The following information MUST be uploaded to the clinic 48 hours prior to spay and neuter surgeries.

Yes, I understand the below information MUST be uploaded to the clinic 48 hours prior to surgeries.

Animal name:

Species:

Dog

Cat

Gender:

Male

Female

Breed for dogs:

Cats:

Long hair

Short hair

Color

Approximate age:

Approximate weight:

Any health concerns or issues? Diarrhea? Vomiting?

For dogs please make sure that both testicles have descended into the scrotum:

Yes, both testicles have descended

Not sure

Finally, the clinic requires documentation of a rabies vaccination. You can take a picture of the rabies vaccination certificate and email it to homes4all@gonetodogs.org If you cannot produce a copy of a rabies vaccination certificate the animal will be given another rabies vaccination. Please indicate if you will be emailing a picture of the rabies vaccination certificate:

Yes, I will email proof of rabies vaccination to homes4all@gonetodogs.org

No, I do not have proof and understand the animal will receive a rabies shot

If you are human, leave this field blank.