FORMS - BENTON CITY CLINIC

 

As a nonprofit, Washington State Law allows us to serve two groups of animals:

  • The first group is unowned animals including feral/stray/abandoned cats and dogs, as well as adoptable animals through other nonprofit rescues and shelters.

  • The second group is privately owned pets of low income qualified individuals-based on federal income guidelines.

LOW INCOME APPLICATION

Instructions: Print out the low income application using Adobe Reader. Complete it. You can either scan it and email it back, or you can mail it to us.  We’ll review and verify the information you provided to determine if you meet our low-income guidelines.  Be prepared to bring in documentation to prove your current status.

If you don’t own a printer check with your local library.  Most libraries have computers and printers that the public can use.  The computer use is usually free. Printing is at a per page fee.

 

 

It is important that you and the animals you are bringing come prepared for the clinic.  Make sure that you have read and followed the instructions for preparing for the clinic.

At least one day prior to the clinic download, print, and COMPLETE the forms below that apply to the animal(s) you’re bringing to the clinic.  It saves time and confusion bringing these completed forms with you when you drop off your animal(s).

Just click on the form(s) that you need for the animal(s) that you’ll be bringing. After the form loads click on the printer icon.  You will need a printer.  If you don’t own a computer the local libraries have computers that you can use for free.  Check with your area library for printing costs.

 

Unsure of how to complete the forms?  Just click on the link at the bottom of the page to view an example of completed forms.

FORMS FOR CATS (3 FORMS)


FELINE SURGICAL RECORDS

Instructions:  Print a copy for EACH cat you are bringing.  Complete the top half of the form up to Clinic Use Only

SURGICAL RELEASE FORM

Instructions: Surgical Release Form for individuals with seven (7) or less cats.  List EACH animal that you are bringing and complete the information for each.

 

RABIES FORM
Instructions:  There are two of the same form per printed sheet.  Print additional sheets if you are bringing more than two cats.  Complete the first two lines of each form you need (one form per cat).

**SHELTER SURGICAL RELEASE FORM**

Release Form for shelters and rescues. Two pages offers more space for the larger number of animals being brought in.

FORMS FOR DOGS (3 FORMS)

CANINE SURGICAL RECORDS

Instructions:  Print a copy for EACH dog you are bringing.  Complete the top half of the form up to Clinic Use Only


SURGICAL RELEASE FORM

Instructions: There are several entry lines per form.  List each animal that you are bringing and complete the information for each.  If you need more print additional release forms.  Two (2) page form for shelters and rescues.

RABIES FORM

Instructions:  There are two of the same form per printed sheet.  Print additional sheets if you are bringing more than two dogs.  Complete the first two lines of each form you need (one form per dog).

**SHELTER SURGICAL RELEASE FORM**

Release Form for shelters and rescues.  Two pages offers more space for the larger number of animals being brought in.