Spay Baton Rouge - Application

To help ensure that our limited resources go to those who most need our help, please apply only if you are in genuine need of our services. Thank you.

Spay Baton Rouge is just one of the low-cost spay/neuter options available in this area; to learn about others, please click here.

Official Spay Baton Rouge Application

A * Denotes a Required Field.

Contact Information
First Name*
Last Name*
Email*
Confirm Email*
Street*
City*
Postal Code/Zip*
Parish*
Home Phone*
Cell Phone
Other Phone

Animal Information
How many animals do you need to get fixed?*

Current Veterinarian*
Have you checked with your vet for a price quote on this surgery?*
If yes, the price was?

Financial Information

Before completing this portion, know that the vet clinic may ask for income verification when checking in your pet for surgery. If you cannot provide proof of the income you indicate in this application, you may be liable for the full cost of surgery. Proof of income may include:

Medicaid, LaCHIP, or Louisiana Purchase Card; or
Recent income tax return confirming the income and household size reported on your application; or
Student ID card and financial aid statement, or a letter explaining your financial situation with supporting Form W-2 if you are employed.

If you cannot provide this documentation, there are other low-cost spay/neuter programs that do not have income qualifications. To find out about them, please visit our Other Low Cost Options Page.

I Consent*

What amount of money can you afford PER ANIMAL for the spay/neuter surgery? We suggest a minimum of $40 per cat or $100 per dog.*

Would you like to make an additional donation?*
Total annual income:* - NOTE: Do not enter commas or periods.
How many people in your household?*
Number of people that income supports*

Please indicate any financial assistance you currently receive by checking ALL applicable boxes:*

(At check-in, you will be asked to verify your responses below by presenting the applicable card(s) together with a valid ID.)

Medicaid

Louisiana Purchase Card

LaChip card

Other Public Assistance (describe below)**

**If you checked "Other Public Assistance" or if you have other information that will help explain your need for our services, please describe in the box below:

Additional Information
Please indicate whether the animal(s) for which you are applying is/are purebred.*
If you answered "Yes", please describe how you acquired your purebred pet(s). If you qualify for our services, you will need to provide this same information in writing to the veterinary clinic at check-in. How many fertile animals will remain in your household once the animal(s) in this application is/are spayed/neutered?*
How did you hear about this program?*

Form Submission
Please click the "Submit Application" button only ONCE to avoid sending duplicates. Your application will be processed, but it may take a few moments. A copy of the application will be sent immediately to the email address provided. Thank you!

IMPORTANT: To make sure you don't miss our reply, please check your "Junk" email folder or better yet, add Spay Baton Rouge [*@spaybatonrouge.org] to your address book or safe list!

By clicking "Submit Application", I certify that all information I have provided on this application is true and accurate to the best of my knowledge. I understand that if I knowingly provide false or inaccurate information and as a result receive Spay Baton Rouge services for which I would not otherwise have qualified, Spay Baton Rouge may at its discretion seek reimbursement from me for the fair market value of those services, and/or disqualify me from receiving future assistance.