DOG – Spay/Neuter Request Form

During the Vet Voucher Program, the Cheboygan County Humane Society will donate $100 towards the spaying (female) and/or $75 towards the neutering (male) of your dog(s). If you are a resident of Cheboygan County please fill out the following form to request a voucher. Note you will be responsible for any additional vet charges on your bill.

"*" indicates required fields

Name*

First Last

Address*

Street Address City State ZIP Code

Phone*

Email*

Number of Dogs to be Spayed/Neutered*

Please enter a number from 1 to 3.

Dog's Name*

Gender*

Any Known Medical issues?*

How Long Have You Cared for this Pet?*

Dog's Name*

Gender*

Any Known Medical issues?*

How Long Have You Cared for this Pet?*

Dog's Name*

Gender*

Any Known Medical issues?*

How Long Have You Cared for this Pet?*

How Did You Obtain the Dog(s)?*

Number of Dogs at Your Residence*

What Vet Office Will Be Used?*

Appointment Date(s)? We will not honor without a scheduled appointment*

How Did You Hear About this Program?*