We took our dog to Petsurg. It's a specialty hospital, but they do low cost spay/neuter. By coming in at my scheduled time, it was nice and quiet. Clean. They really seemed to care, rather than just in/out. Its on the other side of Poway, near Carmel Mt. Rd. I called during their surgery hours and had to leave a message, but they got back to me pretty quickly. (858) 676-1600