Welland SPCA and Human Socity Veterinary Hospital

700 East Main Street

Welland, Ontario

L3B 3Y4

(289) 820-9651

700 East Main Street

Welland, Ontario

L3B 3Y4

(289) 820-9651

CURRENT WAIT TIME: 18 months

An appointment offer will be sent within 30 days of receiving your appointment request form. A response will be required by 10am next day to confirm or decline the appointment - be sure to monitor your junk mail folder.

Dogs - Medium (40-70 lbs)

OWNER'S First Name *

OWNER'S Last Name *

Phone Number (Mobile Preferred) *

Confirm Phone Number *

Email Address *

Confirm Email Address *

Address *

City *

Postal Code *

____________________

Do you have a Pet Promise Agreement from the Niagara or Fort Erie SPCA? *

Found in adoption folder

YES - NIAGARA SPCA
YES - FORT ERIE SPCA
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If adopted, your pet's Animal ID (found on front of adoption folder) *

Dog's Name *

Sex *

Male
Female
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Pet's Date of Birth *

Breed *

Colour *

Estimated Adult Weight (lbs): *

____________________

Please review the following questions regarding your pet's health carefully. Submitting incorrect or incomplete information will delay your appointment booking.

Does your pet have a regular veterinarian? *

YES

Regular Veterinarian's Name:

Clinic Name and Address:

Does your pet have any health concerns? *

Is your pet taking any medication (not including flea/tick/heartworm prevention)? *

Does your pet have a hernia? (Please note, we only offer hernia repairs for females at an upcharge of $40): *

YES
NO
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(Female Dogs Only) Date of last heat cycle (N/A if no heat yet):

(Female Only) Is there a possibility of pregnancy?:

YES
NO
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MALE DOGS: Are both testicles descended? If not, the waiting time may be increased and up to a $200 upcharge will apply. (Female dogs please select N/A) *

Male - YES
Male - NO
Female - N/A
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Does your dog require a muzzle? *

Yes
No
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Is your pet in ideal body condition? *

Review Chart Below

YES
NO
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Ownership Declaration *

I declare ownership and responsibility of the animal listed on this form. All forms, certificates and communication will be addressed to me at the ownership information I provided above. I declare that I am of legal age in the province of Ontario (18).

PLEASE REVIEW THE CURRENT WAIT TIMES AT THE TOP OF THIS PAGE BEFORE SUBMITTING THE FORM.

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700 East Main Street

Welland, Ontario

L3B 3Y4

(289) 820-9651

700 East Main Street

Welland, Ontario

L3B 3Y4

(289) 820-9651