Financial Assistance Application
To be considered for assistance, you must:
1. Be the owner of the pet
2. Be 18 years or older
3. Agree to fill out the application if you move or the number of pets in your household changes
4. Agree you do not breed any of your pets for profit or sport
5. Understand that Hands That Heal RI provides TEMPORARY assistance and you need approval for each additional service for your pets
6. Understand that Hands That Heal RI has the right to deny your application.
Email address *
First Name *
Last Name *
Address *
City *
State *
Zip code
Phone # *
About your pet(s)
Pet species *
How many pets do you have in your household? *
If more than 3, how many?
Pet Name - needing assistance *
Age of pet needing assistance *
Are your pets spayed or neutered *
Are your pets up to date on all their shots *
What type of assistance is this request for? *
Do your pets have medical conditions that need to be addressed? *
If yes, please explain.
Do your pets have any other needs that are not being met? *
If yes, please explain
Name of your Veterinarian *
Veterinarian phone #
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