Cat Haven - Fix-A-Feline Form

The Fix A Feline program has been created for cat owners and caretakers with genuine financial need. To be eligible to receive a free spay/neuter certificate, please complete the form below or submit your application by mail. Click Here for a printable version of the Fix A Feline application in Adobe Document format. If you do not have Adobe Acrobat Reader, click here to download a free version from Adobe systems.

Cats to be spayed or neutered (limit 2 per request):

Cat One*

  Male
  Female

Name

Age

Cat Two

  Male
  Female

Name

Age

First Name:*

Last Name:*

Address:*

City:*

State:*

Zip:*

Home Phone:*

Work Phone:

Cell Phone:

Email Address:*

What is the best time to reach you?

Which method would you prefer a Cat Haven representative use to contact you?

How many people in your household?*

How many cats in your household?*

How many dogs in your household?

Who is your current veterinarian?*

Have you checked with your current vet for a price quote on this surgery?*

Yes If Yes, the price was $
No

What amount of money (if any) can you afford to pay (per animal) toward the spay/neuter procedure?

Total annual household income:*

Please describe your financial situation, checking ALL applicable boxes:

Own Home

Rent

Retired

Medicaid

Public Assistance

Food Stamps

Single Income

Double Income

SSI

Unemployment Compensation

Section 8

Aid to the Aged, Blind, Disabled

Aid to Families with Dependent Children

Hurricane Katrina or Rita

Please add any other information that will help explain your need for funding:

If we are able to help you spay/neuter the animal(s) listed above, how many fertile animals will remain in your household?*

How did you hear about this program?*

I hereby certify that the foregoing information is true and correct and that I have not omitted anything that would make my application false or misleading. I have read and understand the attached information and instructions and agree to abide by them.

Check here if you accept the terms above Date*

Please click the submit button only once as it may take a moment for your submission to process.

All fields with an * are required.