Rochester Community Animal Clinic (RCAC) Spay/Neuter Application

Owner Eligibility
Do you have a voucher to use as payment toward your pet's spay or neuter surgery? *

Yes No
What type of voucher do you have? *

NYS Animal Population Control Program $1 Voucher Spay it Forward Voucher No-Cost Voucher
Please attach a copy of the voucher you intend to use for payment: *

Do you receive public assistance? *
Please select all that apply *

Medicaid / Medical Assistance Food Stamps (SNAP) HEAP NYS Temporary Assistance SSDI SSI
Please attach verification of public assistance here: *

Do you meet any of the Tier 2 qualifications? *
To qualify for Tier 2, you must be a current retiree collecting social security or have an annual income of $40,000 or less as indicated on the 1040 form of your most recent tax return.
Please attach verification of Tier 2 qualification here: *

Is your cat up to date on vaccines? Specifically rabies and distemper (FVRCP) *

Yes No
Please attach current vaccination records here:

About your dog
Pet's Name *
Age (years) *
Age (months)
Sex *

Male Female
Approximate weight (lbs)
Dogs greater than 80lbs do not qualify for our services
Primary breed *
Please specify:
Secondary breed
Primary color *
Secondary color

Is your dog current on vaccinations, specifically rabies and distemper (DHPP)? *

Yes No
Please attach current vaccination records here:

Is your dog currently on any medications or supplements (prescription or over-the-counter)? *

Yes No
Please list (include medication name, dosage, and reason for use):

Has your dog ever shown any signs of aggression (with other animals or with people) or are you concerned about your dog being aggressive? *

Yes No
Please explain:

Congratulations!

It appears that your pet qualifies for surgery at our clinic.
Please select any additional services you would like your pet to receive in addition to surgery:

Rabies vaccine - INCLUDED IN THE PACKAGE PRICE AND REQUIRED (unless current vaccine proof shown 48 hrs. prior to appt.) FVRCP vaccine - INCLUDED IN THE PACKAGE PRICE Revolution Plus one-month flea treatment - $13 Combo testing for Feline Leukemia and Feline Immunodeficiency Virus - $31 Nail trim - $10 Microchip - $40 Droncit Injection (treatment for tapeworms) - $10

Congratulations!

It appears that your pet qualifies for surgery at our clinic.
Please select any additional services you would like your pet to receive in addition to surgery:

Rabies vaccine - INCLUDED IN PACKAGE PRICE AND REQUIRED (unless current vaccine proof shown 48 hrs. prior to appt.) DHPP vaccine - INCLUDED IN PACKAGE PRICE Parastar flea treatment - $11 Heartworm disease test - $25 Heartworm disease PLUS tick-borne disease testing - $32 Nail trim - $10 Microchip - $40

Please click the "SUBMIT" buttom at the bottom.

Due to very high numbers of surgery applications, there may be a several month wait before we are able to schedule your pet's surgery appointment.

(We currently have a 4-6 month wait for female cats and a 2-5 month wait for all others.)

Once we get down to your application and are ready to schedule your pet's appointment, we will call you for payment. (All surgeries must be prepaid in full in order to schedule.)

Please be patient as we strive to get as many dogs and cats in for surgery as quickly as possible. If you have not heard from us within two months from the date you submitted your application, you are welcome to call for an update regarding where you are on the waiting list.
Your surgery package price (depending upon your pet's species, gender, and weight) can be found on our website.
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Owner Eligibility