Spay and Neuter Clinic Form September | Lucy Mackenzie Humane Society

Please fill out registration form and pay securely via PayPal.

Company
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Clinic Date: September 28, 2026 Please arrive between 8 – 8:30AM for check-in
Name*
First Last
Email*
Enter Email Confirm Email
Address*
Street Address Address Line 2 City State ZIP / Postal Code
Cell Phone Number*
Animal Name*
Color*
Species*
Sex*
Age (Please specify years or months)*
Breed*
If other, please specify
Animal History – Distemper Vaccination*
Animal History – Rabies Vaccination*
If possible, please upload a copy of their vaccination records
Rabies
Max. file size: 1 GB.
All animals must have proof of Rabies vaccination or receive the vaccination at the clinic.*
I will bring proof of vaccination or will pay $15 for my animal to receive the rabies vaccination at the clinic
Has the animal ever been to a Veterinarian?*
Where did you obtain your pet?*
If other, please specify
Has this animal produced a previous litter?*
If yes, how many litters?
Any health problems or previous surgery?*
Procedures – Cat*
Option
FVRCP Vaccine
Rabies Vaccine
Selamectin
Microchipping
Total
$0.00
This fee is NON-REFUNDABLE and is required to hold your spot for the clinic
Payment Method*

American Express
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MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name