VET Care Assistance Application
In most cases, we will not approve assistance for animals that are not a spayed or neutered. Pet owners must agree to have their animal spayed or neutered when accepting financial assistance from our organization. We also do not approve already incurred vet bills. We want to help the person who is faced with a temporary crisis and otherwise would have nowhere to turn to ensure the health of their pet. Partial grant will be awarded to those who fall under our guidelines of need and Animal Donation Advocate will send a check to your Veterinary Hospital to be credited to the pet that is approved account. We cannot issue payment without the provider’s federal identification number. More information about our GUIDELINES FOR VETERINARY ASSISTANCE can be found in the link below! GUIDELINES FOR VETERINARY ASSISTANCE







Address Line 2


Poztal/Zip Code

State / Province / Region


Referring person or veterinarian? Or how did you hear about us?

Do you have a full or part-time job? Where?

Have you recently lost your job or been laid off?


Do you expect to return to work?

YesNoNot applicable

How many people in your household?

Are you receiving any public assistance?


What kind of public assistance are you receiving? Or Not applicable?

Do you live on disability-only income?


Do you live on social security-only income?

Can you provide documentation of your financials if asked?

What is your current household monthly net income?

Have you asked for vet care assistance from us before?


Were you approved before?
YesNoNot applicable

What pet were you approved for? The same one or a different pet? Or not applicable?

How much money were you approved for? Or not applicable?

Have you applied for assistance with any other organization?


If you answered YES, you must list the names of the Organizations you applied for assistance -

How many dogs do you have?

How many cats do you have?

How many other pets do you have?

If you do not have any other pets, type - none

Are your pets up to date on vaccinations?

If some of your pets are up to date and some are not, please describe in the box below which animal is and which on is not.M


Fill this box is you answered YES and NO above

Are your pets Spayed or Neutered?

If some of your pets are Spayed or Neutered and some are not, please describe in the box below which animal is and which on is not.


Fill this box is you answered YES and NO above

Pet's Name

Type of Pet

What is the pet's age?

Describe the problem

Date of the Incident

Upload Photo

By Checking this box you agree to use one of our qulified Vet offices, and gurantee that the information you provided in this form is true and correct


Type your name here if you attest to the fact that the above information given is correct in the application


Please enter any two digits

Example: 12