Best Friends of Pets Spay Neuter Assistance Program

PO Box 14547 Oklahoma City, OK 73113-0547

(405) 418-8511 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 PLEASE PRINT. USE BLACK OR BLUE INK.

LAST NAME, YOUR FIRST NAME 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 _________________________________________________________________________________________________________________________

BEST FRIENDS OF PETS - Spay Neuter Assistance Program

Participating Veterinary Clinics by Location

Location or Closest

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NW 39th & Council Bethany Animal Hospital $ + 787-1222 12w 2# 12w 50#

NW 23rd & Council Council Veterinary Hospital $ + @ 787-1001 3# 3# 75#

NW 46th & Classen Pet Friends Veterinary Hospital $ + 843-4711 8w 2# 8w 2# 50#

Britton & Rockwell Rockwell Pet Clinic + 728-7387 10w 5m 40#

NW 43rd & MacArthur Warr Acres Animal Clinic + 787-9000 12w 12w

SW 57th & Penn Animal Wellness Center of OKC $ 896-2120 8w 2# 8w 2# 8y 8y

135th & S. Western Boyer Veterinary Clinic ** 794-8504 8w 2# 8w 2# 15# 85#

SE 44th & Sunnylane Oakwood Veterinary Clinic ** 672-5574 6m 6m

60th & S. Western OK Humane Place Spay/Neuter Clinic $ 947-7729 8w 2# 8w 2#

85th & S. Western South Western Pet Clinic 632-0584 16w 3# 16w 3# 7y 7y 65#

Blanchard Blanchard Animal Hospital ** +! @ 485-3992 12w 12w 6y 6y

Choctaw Town and Country Animal Hospital $ ** + @ 769-5697 4m 3# 5m 3# 10y 10y

Del City Wellington Parke Animal Clinic $ 605-6675 8w 2.5# 8w 2.5# 10y 10y 100#

Edmond Feline Medicine & Surgery ** + 844-5489 4m 4# 1y 10#

El Reno 4V Animal Clinic ** 262-2245 3m 3m

Meeker Meeker Animal Hospital 279-2727 8w 2# 4m 2# 7y 12# 5y 60#

Midwest City Midwest Veterinary Hospital + 732-4505 6m 6m

Midwest City Post Road Pet Clinic 732-4599 6m 6m

Moore SpayXperts $ 217-9700 12w 2# 12w 2# 18# 80#

Mustang Mustang Animal Health Clinic + 376-4556 3m 6m 6y 6y 100#

Noble Noble Animal Clinic $ 872-8382 4m n/a 4m n/a 100#

7/24/2018

BEST FRIENDS OF PETS - Spay Neuter Assistance Program

Participating Veterinary Clinics by Location

Location or Closest

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Norman Cats Only Veterinary Clinic + 579-4228 3# n/a n/a n/a n/a

Norman Main Street Veterinary Hospital @ 329-6555 3m 3# 3m 3#

Norman University Animal Hospital + 329-6889 5m 5m

Shawnee Angels for Animals $ 765-3223 8w 2# 8w 2# 10y 10y

Shawnee

Best Friends Animal Clinic

(not a part of Best Friends of Pets) $ 273-5617 8w 2.5# 8w 2.5# 10y 10y 100#

Wanette Cedar Creek Veterinary Clinic $ + 383-2000 6-12w n/a 6-12w n/a n/a n/a n/a n/a

Yukon Yukon Pet Care Clinic 603-4800 6m 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 fees.

@ 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