Wellness Clinic Application

Use this form to apply for discounted Wellness Clinic services through the Windham County Humane Society.

Wellness Clinics are held twice a month in Brattleboro and once a month in Wilmington.   Pets will be scheduled in the order in which applications are received.  You will receive a letter in the mail with the date, time, and location of the clinic your pet is scheduled for.  Wellness Clinics are for basic pet care only and are not to take the place of your regular veterinary visits.  Please contact the Windham County Humane Society at 802-254-2232 if you have any questions about our program.   

Information about You
Name *
Name
Home Phone
Home Phone
Cell Phone
Cell Phone
Work Phone
Work Phone
Your Address *
Your Address
Information on pet(s) to be seen at the Wellness Clinic
Please tell us about each of your pets. Due to limited space, we can only schedule two pets per person per clinic. If you have additional pets that need to be seen for pet care, please fill out a separate application.
Pet One
Pet Type *
Gender of the pet *
Spayed or neutered? *
Please indicate what services this animal needs. *
Pet Two (Optional)
Pet Type
Gender of pet
Spayed or neutered? *
Please indicate what services this animal needs. *
Terms
With my acknowledgement, I certify that the information I have given is true. I understand if I am scheduled for a clinic and fail to appear without notice, I forfeit my eligibility for the program. I affirm that I am a resident of Windham County, Vermont.
I agree to the program's terms as enumerated above.
PLEASE REMEMBER TO CLICK ON THE RECAPTCHA "I AM NOT A ROBOT" BUTTON AT THE END OF THE FORM. IF THIS BOX IS NOT CHECKED, THE FORM WILL NOT BE SUBMITTED.
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