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Spay/Neuter Request Form Template

Simplify Your Spay and Neuter Appointment Process

When it comes to managing spay or neuter appointments, you may find it challenging to keep everything organized and efficient. Our Spay/Neuter Request Form Template is designed for shelters and foster organizations looking to streamline appointment requests. This template simplifies the process, helping you quickly gather necessary information, ensure better communication with foster families, and maintain accurate records. Plus, it's easy to customize to fit your specific needs and WCAG-aligned for accessibility. Explore the template and improve your appointment management today.

Full name
Email address
Primary phone number
Street address, city, state, ZIP
Preferred contact method
Phone call
Text message
Email
Any
How many pets are you requesting surgery for?
1
2
3
4+
Primary pet name
Species
Dog
Cat
Rabbit
Other
Please Specify:
Sex
Male
Female
Unknown
Requested procedure
Spay (female)
Neuter (male)
Unsure
Age (years/months)
Approximate weight
Is this a feral/community cat?
Yes
No
Not applicable
If a feral/community cat, is this request for TNR services?
Yes
No
Not applicable
Is your pet up to date on rabies vaccination?
Yes
No
Unsure
Is your pet currently in heat?
Yes
No
Not applicable
Could your pet be pregnant?
Yes
No
Unsure
Not applicable
Any known medical conditions?
Current medications or supplements
Any previous reactions to anesthesia or surgery?
Has your pet bitten or scratched anyone in the past 10 days?
Yes
No
Prefer not to say
Preferred appointment date
Are you flexible with appointment date/time?
Yes
No
Do you need transportation assistance?
Yes
No
If this is for TNR, do you have access to a humane trap?
Yes
No
Not applicable
City or county of residence
Are you 18 or older and the legal owner or authorized caretaker of this pet?
Yes
No
Household income range (optional)
Under $25,000
$25,000-$49,999
$50,000-$74,999
$75,000-$99,999
$100,000+
Prefer not to say
Add a microchip during surgery
Yes
No
Unsure
Provide core vaccines if due
Yes
No
Unsure
I understand the risks of anesthesia and surgery and give permission to proceed.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I will follow all pre- and post-operative instructions and arrange same-day drop-off and pick-up.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I agree to the clinic's cancellation and no-show policy.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
Type your full legal name as your signature
Signature date
I confirm the information provided is accurate to the best of my knowledge.
True
False
How did you hear about this program?
Search engine
Social media
Friend or family
Veterinarian
Rescue or shelter
Flyer or event
Community cat/TNR program
Other
Please Specify:
{"name":"Full name", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Full name, Email address, Primary phone number","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
Paper art illustration depicting a spayneuter request form for a veterinary service article.

When to use this form

Use this form to collect and schedule sterilization services for owned pets, fosters, and rescue intakes. It suits shelters coordinating voucher spots, clinics running low-cost days, and rescue groups prepping animals before adoption. Ask owners to submit pet details, preferred dates, and funding needs so you can triage and confirm quickly. If the procedure ties to an adoption, keep records aligned with your Adoption agreement form. For litters, link requests to your Simple kitten adoption form so each kitten is tracked and cleared before going home. You can also note if the owner needs transportation help or post-op supplies. The result: fewer back-and-forth emails and faster surgery approvals.

Must Ask Spay/Neuter Request Questions

  1. What species, breed, age, sex, and approximate weight is your pet?

    These basics determine eligibility, anesthesia dose, and timing, especially for very young or senior patients. They also guide species-specific care, including rabbits managed through the Rabbit adoption application form.

  2. Has your pet had prior illnesses, surgeries, vaccines, or reactions to anesthesia?

    Medical history flags risks and may require a pre-op exam or bloodwork before booking. It helps your team plan pain control and decide if the pet needs a different protocol.

  3. Is your pet in heat, pregnant, nursing, or recently postpartum? If so, when?

    Reproductive status affects surgical risk, procedure time, and cost, so accurate timing helps you schedule safely. It also sets expectations for recovery and whether you should delay the procedure.

  4. Can you transport your pet on the scheduled date, and will you follow fasting and aftercare instructions?

    Clear commitments reduce no-shows and complications from feeding or missed meds. If transport is a barrier and relinquishment is possible, coordinate next steps through the Owner surrender request form.

  5. Do you need proof of surgery for licensing, rescue records, or adopters, and what name should appear on the certificate?

    Knowing this upfront lets you issue the right paperwork or match your records to a spay neuter certificate template or neuter certificate template if your program uses one. It prevents reprints and ensures agencies accept your documentation.

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