Dog Desexing Application Form

Dog Desexing Program Application

Your Full Name (First and Last)

Phone Number

Street address

Town/Suburb

Concession Card Type and Number

Identification Type and Number (showing current address)

Dog's name

Are you the legal owner of this Dog?

Dog's Breed

Dog's Age

Dog's Gender

Dog's estimated weight (in kgs)

Is the Dog microchipped?

Microchip Number (if known)

Does your Dog have any medical or behavioural issues?

If so, please provide details

Dog's usual Vet

By applying, you consent to our Vet reaching out to your Vet (if required)

Describe how you will be able to provide appropriate post op care for your Dog (keeping e-collar on, dry, clean, rested for at least 10 days)

I confirm the following statements :

** I am over 18 years of age

** All information in this application is true and correct

** I am the legal owner of the dog listed in this application

** If I am accepted into the program I will comply with the obligations and requirements

Upload photo of concession card

Upload photo of Identification Document

Identification must include the current address listed on this form.