Spay Today PO Box 340 Charles Town, WV 25414 Hillside Veterinary Hospital 191 Augustine Ave Charles Town, WV **You pay Spay Today at the time of setting an appointment; this may be done by mail, in person, or over the phone with a credit card. We are not able to take payment over the internet. Administration fee: (required with each payment) ……………………..…………..$5 (Please circle procedure(s) requesting) Cats: must be 5 mo + Female Spay Rabies required Feline Distemper (each) $95.25 $17.63 $17.14 Dogs: must be 5 mo + Female Spay (under 20 lbs) Female Spay (21 – 50 lbs) Female Spay (51 - 80 lbs) Female Spay (81 – 100 lbs) Female Spay (101 lbs +) Rabies required Bordetella Required Information: $130.50 $138.75 $147.75 $155.81 $201.26 $17.63 $17.14 Male Neuter Combo Test Feline Leukemia Vaccination (each) $56.25 $36.00 $17.14 Male Neuter (under 20 lbs) Male Neuter (21 – 50 lbs) Male Neuter (51 - 80 lbs) Male Neuter (81 – 100 lbs) Male Neuter (101 lbs +) Distemper (each) $99.00 $107.25 $115.50 $132.00 $158.18 $17.14 $33.45 Heartworm/Lyme/Ehrlichia Test Name: ____________________________________________ Address: _______________________________________________________________ _______________________________________________________________________ Home Phone: _______________________ Work Phone: ______________________ Required Pet Information: Name: _________________________________ Age: ______________________________ Breed (Dog): ____________________________ Color: ______________________________ Breed (Cat) Hair Length (Circle one): Short - Medium – Long Weight (Dog only):____________ My pet is up-to-date on rabies (Must provide certificate at drop off). Payment information: Make payable to: Spay Today Total of procedure(s) requested: $__________ One time Administrative Fee: $ + 5.00 Total amount due: $ _________ 2/12/2016 Drivers License Number (if paying by check) State_____#_________________ To set an appointment you may come in person to Briggs Animal Adoption Center, mail payment and information or call Spay Today and schedule over the phone with a credit card. You pay Spay Today, we set the appointment and we will go over the pre-surgery instructions with you. Hours Mon Tues Wed Thurs Fri Sat Sun 7:30am 7:30am 7:30am 7:30am 7:30am 8:00am closed 7:00 PM 5:00 PM 5:00 PM 7:00 PM 5:00 PM 12 noon 191 Augustine Ave Charles Town WV 25414 Phone: 304.728.2203 FAX: 304.724.0056 email hillsidevet@comcast.net Notes and Restrictions Keep records given at time of discharge, you will not be able to get a new copy. Pre-Surgery Instructions: - No food or drink after 8 pm the night before surgery. - Coupon must accompany pet at time of drop off - Drop off time is between 7:30am – 8:30am. New clients required to fill out information sheets upon arrival. - Cats must be in carriers and dogs must be on leash. - If cat/dog is in heat or pregnant, if dog weight is incorrect, you must pay the hospital the difference when your pet goes home. 2/12/2016