November 14, 2026 Vaccination Clinic Application,

NORTHEAST MISSOURI HUMANE SOCIETY

Vaccine Clinic Application
Any dog that needs to be muzzled, must be done before the dog is brought into the building. If you need a muzzle we will have some available. If this does not occur, you will run the risk of being turned away. This is policy that has been established for the safety of the animals as well as our staff and volunteers.

No Retractable leads will be allowed. We will have leashes available to use, if needed.

NO Feral Cats will be allowed.

The Vaccination Clinic was established through a grant provided by the Petco Love Foundation.

This program provides a Rabies vaccine and the DAPPV vaccine for DOGS and Rabies vaccine and FVRCP vaccines for CATS.

We reserve the right to refuse to vaccinate any animal that the veterinarian deems too aggressive.
Unfortunately, due to higher vaccine costs, the Northeast Missouri Humane Society will have to charge a $15 fee per animal vaccinated.

That price will cover:

Cats: Rabies and FVRCP

Dogs: Rabies and DAPPv

We will also be offering microchipping at $15 per animal.
VACCINATION CLINIC:

November 14, 2026
OWNER INFORMATION
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone

Area CodePhone Number
Number of animals today:
Dogs
Cats
PLEASE LIST PETS
1. Name of Pet
Spayed or neutered?
Dog/Cat
Gender
Age
Breed
Color/Description
Has this animal ever had an allergic reaction?
If so please explain:
2. Name of Pet
Spayed or neutered?
Dog/Cat
Gender
Age
Breed
Color/Description
Has this animal ever had an allergic reaction?
If so please explain:
3. Name of Pet
Spayed or neutered?
Dog/Cat_
Gender
Age
Breed
Color/Description
Has this animal ever had an allergic reaction?
If so please explain
4. Name of Pet
Spayed or neutered?
Dog/Cat
Gender
Age
Breed
Color/Description
Has this animal ever had an allergic reaction?
If so please explain
Please submit n/a if this is not needed at your visit.
Number of microchips needed:
Appointment Time

Please choose a time for appointment. It DOES NOT matter how many animals you are bringing, you just need 1 appointment time.
Choose one time.
Pick a payment option:
Payment
Stop!-Are you paying the day of the appt? Skip the following information and go to submit and email!

My Products

Vaccine

per animal

$15.00 Quantity

Microchip

per animal

$15.00 Quantity

Subtotal

Tax

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

There will be no refunds unless you call and cancel your appointment at least 24 hrs before the clinic.
Email
example@example.com
Should be Empty:

NORTHEAST MISSOURI HUMANE SOCIETY

VACCINATION CLINIC:

OWNER INFORMATION

PLEASE LIST PETS

Appointment Time

My Products