Individual Application for Assistance
Operation D.O.G. makes every effort possible to use funds in the most responsible way. Unfortunately, not all cases can be accepted. We will contact all applicants as soon as possible after the funding request is received. Please see our website at www.operationdog.org for more information on funding requirements.
Email address *
Name *
Address *
Phone number
Dog's Information
Please provide the following information about the dog in need of medical care:
Dog's Name: *
Dog's Breed (or best guess if unknown): *
Dog's age (or best guess if unknown): *
How long have you owned your dog?
Current veterinarian: *
Veterinarian Phone:
Has the medical care already been provided? (if yes, please include an itemized bill for the care received) *
Has the medical care already been paid? *
Please describe the medical care your dog needs: *
Is the medical care needed an emergency? *
Would you be willing to have your pet receive care at one of our partner veterinarians if the care is more affordable? *
What is the approximate amount of financial assistance you are requesting? (if known)
What amount are you able to contribute toward your dog's care?
Is your dog spayed or neutered? *
If no, are you willing to spay or neuter your dog as a part of the funding received from Operation D.O.G.? *
Please provide us with a copy of documentation of your income (income tax, recent paystub, etc...) OR if you do not meet the income guidelines for assistance, please provide us with supplemental documentation or details below regarding why you are unable to afford care for your dog at this time. *
If you are working with other organizations for funding, please complete the following information. I am also receiving financial assistance for my dog's medical needs from these organizations:
I will send a written estimate of care from my veterinary provider to Operation D.O.G
I will send proof of income or supplemental documentation demonstrating a need for financial assistance to Operation D.O.G *
By submitting this application, I attest that I am the legal owner of the dog for who I am completing this application and I have answered the questions in this document honestly and to the best of my knowledge. I agree to allow Operation D.O.G. to use my story and photos of my dog on their website, for social media, or for other marketing materials. I will not hold Operation D.O.G. liable for any medical outcomes for my dog. I understand that Operation D.O.G. will provide payment directly to the medical provider and may determine to not provide funding at any time due to any reason.
Please type your name and today's date to verify the above:
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