Spay/Neuter Voucher

$70 Male Dog | $85 Female Dog | $55 Male Cat | $65 Female Cat IF YOUR ANIMAL IS OVER 40LBS, THE CLINIC CAN/WILL CHARGE AN ADDITIONAL $10 PER PET. NO PETS OVER 90# can take part in this program unless the clinic has approved it.

Individual or Couple *	Individual Couple
Primary First Name *
Primary Last Name *
Primary Phone *
Primary E-mail Address *
Secondary First Name *
Secondary Last Name *
Secondary Phone *
Secondary Email
Address *
City *
State *	AR MO OK
Zip Code *
Pet's Name *
Gender	Male Female
Species *	Dog Cat
Choose a Vet Clinic *	Bella Vista - Village Pet Hospital Bentonville - Oakwood Pet Hospital Fayetteville - All Cats Clinic Fayetteville - Animal Medical Clinic Fayetteville - Best Friends Animal Hospital Fayetteville - Cornerstone Animal Hospital Fayetteville - Gulley Park Pet Clinic Fayetteville - Stanton Animal Hospital Huntsville - Huntsville Vet Clinic Lincoln - Lincoln Vet Clinic Lowell - Lowell Vet Clinic Pea Ridge - Oakview Vet Clinic Rogers - New Hope Animal Clinic Springdale - Lunsford Vet Care Clinic Springdale - Lyons Vet Hospital Springdale - Springdale Animal Hospital Springdale - St. Francis Animal Hospital Springdale - Southwest Pet Hospital Southwest City Veterinary Clinic, Southwest City, MO West Fork - Smithers Animal Hospital
This should be a vet clinic you have already spoken with or currently use. If not, please verify they are accepting our vouchers and new patients!
Terms & Conditions Agreement I agree to pay a participating veterinarian the above-indicated fee to have my animal spayed or neutered. I will pay the fee when I drop my pet off for surgery. I release the Humane Society of the Ozarks from responsibility for all liability concerning the sterilization procedure. I understand that it is my responsibility to schedule an appointment for surgery directly with a participating veterinarian. Finally, I understand that the indicated fee covers only the cost of the sterilization and does not cover any additional charges that the vet may find necessary. Such additional costs could include a rabies vaccination or cost associated with any female animal who may be in heat or pregnant at the time of service. The vet should make clear any additional charges before surgery. It will be my responsibility to pay for those charges. By typing my name below, I am stating that I have read all fine print within the terms and conditions and agree to all.
E-Signature (type full name) *

For Office Use Only:

HSO Rep ESignature: Chase Jackson, President
____________________________________________________________		______________________________
Vet Rep Signature and Date		Surgery Completion Date

Please return this voucher with invoices attached to hsoadmin@hsozarks.com or mail to: 11204 Nile Ave Oklahoma City, OK 73114 (Temp Mailing Address).