Spay/Neuter Voucher Application

This application is ONLY for domestic cats and dogs (family pets).

Applications who do not meet eligibility requirements will be denied.

Furever Family Spay/Neuter Voucher Program

"*" indicates required fields

Step 1 of 5 - Contact Information

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email Adress*

Enter email address

Confirm Email*

Are you single or married?*

Single

Married

Household Monthly Income

Please be honest and include income from all sources from your household.

Are you employed?*

Yes - Full Time

Yes - Part Time

No Employment

Name of your Employer

Please provide the Company name and your position or title with your employer.

Total Monthly Household Income:*

What is the total monthly (not annual) income of your entire household. Please include ALL forms of income, including income from employment, child support or alimony, rental, pension or retirement income AND any income from government programs, including Social Security, Disability or other assistance programs.

Enter the total number of people in your Household*

Enter the total number of people living with you.

Please provide details on your sources of income:*

Please provide explanations and details on the sources of income for your household.

Does your household pay rent or mortgage?*

Yes

Own Home, no mortgage.

What is your monthly rent or mortgage payment?*

Please enter the total amount you pay to a bank or landlord.

What is your portion of the monthly rent or mortgage payment?*

If you split with someone, please note only YOUR portion.

Do you have any legal dependents?*

This would be children for which you are legally obligated.

Yes

How many dependents?*

Please provide an explanation of your financial hardship.*

Our spay and neuter vouchers are reserved for individuals or families facing substantial financial difficulties. Please provide details about your circumstances and explain why you are unable to cover the cost of surgery for your pet at a low-cost clinic on your own.

Do you receive any form of financial assistance?*

Housing Vouchers

SNAP / EBT / WIC

MediCARE or MediCAL

Student Financial Aid

CalWorks

Financial aid for school

Other Not listed

None of the above

Are you able to provide proof of your low income status for assistance received?*

Yes, I can provide proof

No, I can not provide proof

Are you a current or former member of the military?*

Yes, Current Member or Active Reserve

Yes, Former Military (Veteran)

Are you 62 Years or Older?*

Yes

Prefer not to answer

Number of unspayed/unneutered pets in your household*

Have you received assistance from Furever Family in the past?*

Yes

Are you affiliated with a rescue or animal welfare group?*

Yes

Please note which rescue or organization and in what capacity you are involved.*

Please note that you will no longer be eligible to receive vouchers from Furever Family if information is falsified or omitted.

Additional Costs and Responsibility*

If approved, you will be required to make a $50 deposit per pet (if more than one) to confirm your surgery appointment. You will also have a balance due at the time of surgery. The remaining balance amount will be determined upon reviewing your application and will be provided to you prior to booking your appointment.

I understand a $50 deposit per pet (if more than one) will be required to confirm my appointment if approved

How much can you pay towards the cost of your pet's surgery? View surgery prices on our website before answering this question.*

Furever Family relies solely on donations from individuals and does not receive government funding. Orange County does not offer completely free spay and neuter programs. We want to help as many pet owners as possible, so we ask that applicants to this program are truthful in their responses regarding the amount they can afford to contribute.

Pet's Name*

How long have you had your pet?*

Where did you get your pet?*

If other, please explain.*

Age*

Indicate years, months, or weeks.

Sex*

Female

Male

What type of pet?*

Dog

Cat

Breed*

Color of Pet*

Current Weight*

Please enter weight in pounds (lbs)

Has your pet received any vaccinations in the past?*

Yes

Unsure

Pet History Information

Is your Pet Microchipped?*

Yes

Please enter Microchip Number:

Is your pet fearful of strangers or has it ever shown aggression towards humans?*

Yes

Is your pet aggressive towards other animals? (Please provide brief explanation)*

Write "No" if not

Has your pet ever had a seizure or adverse reaction to a vaccine, medication or anesthesia?*

Yes

Has your pet been bitten by another animal or has it bitten a person or other pet within the past 30 days?*

Yes

Is there a possibility that your pet may be pregnant?*

Yes

Has your pet given birth to a puppy or kitten within the past 4 weeks?*

Yes

Have you seen any worms in your pet’s stool or does your pet scoot its rear end on the ground?*

Yes

Has your pet been diagnosed with any abnormal health condition?*

Yes

Has your pet been on any medication other than flea/tick control within the last 30 days?*

Yes

What medications is your pet on?*

Last date flea or parasite control medication was given to your pet (oral, topical, flea shampoo, flea collar, etc.):

Has your pet experienced any signs of illness or injury within the past 2 weeks? (Check below for all that apply)*

None

Sneezing

Coughing

Vomiting

Diarrhea

Constipation

Loss of, or increased appetite

Weight gain or loss

Other

Please Explain other illness or injury not listed:*

Are you applying for a second pet?*

Yes

2nd Pet's Name*

How long have you had your pet?*

Where did you get your pet?*

If other, please explain.*

Age*

Indicate years, months, or weeks.

Sex?

Female

Male

What type of pet?*

Dog

Cat

Breed*

Color of Pet*

Current Weight*

Has your pet received any vaccinations in the past?*

Yes

Unsure

Please upload copies of current vaccinations for your pet (if applicable):

Drop files here or

Accepted file types: jpg, png, pdf, heic, Max. file size: 2 GB.

Pet 2 History Information

Is your pet Microchipped?*

Yes

Please enter Microchip number:*

Is your pet fearful of strangers or has it ever shown aggression towards humans?*

Yes

Is your pet aggressive towards other animals? (Please provide brief explanation)*

Write "No" if not

Has your pet ever had a seizure or adverse reaction to a vaccine, medication or anesthesia?*

Yes

Has your pet been bitten by another animal or has it bitten a person or other pet within the past 30 days?*

Yes

Is there a possibility that your pet may be pregnant?*

Yes

Has your pet given birth to a puppy or kitten within the past 4 weeks?*

Yes

Have you seen any worms in your pet’s stool or does your pet scoot its rear end on the ground?*

Yes

Has your pet been diagnosed with any abnormal health condition?*

Yes

If Yes, Please explain the health condition(s)*

Has your pet been on any medication other than flea/tick control within the last 30 days?*

Yes

What medications is your pet on?*

Last date flea or parasite control medication was given to your pet (oral, topical, flea shampoo, flea collar, etc.): If not applicable please write "None"*

Has your pet experienced any signs of illness or injury within the past 2 weeks? (Check below for all that apply)*

None

Sneezing

Coughing

Vomiting

Diarrhea

Constipation

Loss of, or increased appetite

Weight gain or loss

Other

Please Explain other illness or injury not listed:*

Terms*

I declare under penalty of perjury that the information provided above is true and correct to the best of my knowledge, that I am at least 18 years of age and I give Furever Family permission to verify any information provided. I understand that if my application is approved, Furever Family will share my information with the contracted provider for the purposes of providing veterinary care and services to my pet.