NDM Pet Owner Registration Form

Veterinary Clinic Details

Clinic Name

Clinic Address

Street Address City State / Province / Region ZIP / Postal Code Country

Clinic contact number*

Your Info

Name*

Postcode*

Mobile number*

Email*

Your Pets Info

Pet Type*

Pet Age

Multiple Pets

e.g. 3x male cats 5mo, 3x female cats 2yo

What motivated you to desex your pet at this time?

My vet recommended it

To prevent unwanted litters

Behavioural reasons

Health reasons

My pet keeps straying/escaping

Discounted pricing or financial support made it more affordable

I saw the National Desexing Month campaign

Council or organisation referral

Other

How did you obtain your pet?

Adopted from an animal welfare organisation

Purchased from a breeder

Purchased through private seller or online advertisement

Given free by friends/family

Found/stray

Born from another pet I own

Other

Is your pet microchipped?

Yes

Unsure (adopted/stray)

Vaccination Status

Up to date

Overdue

Never vaccinated

Unsure (adopted/stray)

Would you have desexed your pet without this vet clinics discount?

Yes

Maybe, but later

No, cost was a barrier

Unsure

Help improve affordable desexing programs in Australia

Yes, I’m happy to receive a short follow-up survey by SMS or email after National Desexing Month.

This field is for validation purposes and should be left unchanged.

NDM Registration Form

Veterinary Clinic Details

Your Info

Your Pets Info