Request edit access
Admissions Consultation Request Form
Thank you for reaching out to Lollypop Farm for help. We understand what a hard time this can be, and we are here to help you make the best decision for you and your pet. Your responses to the following questions will help us understand the challenge you and your pet are facing.

  Please fill out this form to the best of your ability and an admissions counselor will reach out to help as soon as possible. If you have already left a message on our Admissions voicemail, you do not need to fill out this form. It may take up to 24-48 hours for us to respond to your request, but we will be in touch as soon as possible.
Sign in to Google to save your progress. Learn more
Email *
Name *
Phone Number *
What county do you live in? *
Type of Pet *
How long have you had the animal(s)? *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Lollypop Farm, the Humane Society of Greater Rochester. Report Abuse