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Female Dog Application

Are you on any government assistance?

If yes: Upload proof of income or EBT card, FNS, SNAP, WIC, CHIP, Veterans Pension

If you are unable to submit your application due to difficulty attaching proof of income, please email acc.clinic@charlottenc.gov for assistance. You will not be able to submit an application without the proof.

We will be reaching out to you by phone first. If we cannot reach you, we will contact you by email.

Full Name

Full Address

Previous Address

Proof of residency is required. Please upload one of the following: 

  • Government-issued ID showing a Mecklenburg County address (must be current)
  • Utility bill (water, power, or gas issued within the last 60 days)
  • Lease or rental agreement (must show client name and address) 
  • Most recent mortgage statement 
  • Official mail from a government agency (dated within the last 60 days)

Please upload proof of residency

Owner's Birthdate

Only Speak Spanish?

PLEASE READ BEFORE PROCEEDING
Your pet must be AT LEAST 4 months old for the veterinarian to perform the surgery.

If your pet is PAST their 7 year birthday, it is strongly recommended you provide pre-anesthetic bloodwork from a veterinarian service to identify any potential health concerns that may not be obvious upon physical examination. If you do not provide any bloodwork and proceed with the spay/neuter surgery, you acknowledge underlying metabolic and endocrine abnormalities may occur.

A physical exam will be performed on the day of surgery. Animals that are NOT considered safe candidates for anesthesia will be declined from having the surgery performed.

Is your female dog pregnant? (Our veterinarian will need to know prior to surgery if your dog is pregnant or may be pregnant)

Is your female dog lactating? (nursing babies)