Harmony High School Clinic Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email* Phone*Secondary PhonePet's Name* Pet's Age* Less than 8 years old 8 years or older If they are 8 years or older, we will have to have bloodwork done prior to the appointment to make sure your pet is healthy enough for the procedure. We charge $70 but you can bring results from another clinic if it was done in the last 6 weeks. My Pet is a* Dog Cat Qualification*Please check all that apply: Proof is required at the end of this form. Documentation must be uploaded in order to qualify. Household information must be provided if Financial is selected. Medicaid Unemployment WIC SNAP Active/Retired Military SC8 BIA General Assistance HEAD START TANF FDPIR Financial My Pet is spay/neutered* Yes No Household*How many people and pets are in your household (including yourself)?Please enter a number greater than or equal to 1.Service request*What Veterinary services are you looking to get right now?File upload*Please upload the program qualifications here. At least one is required. Drop files here or Select files Max. file size: 25 MB, Max. files: 2. CAPTCHA
