2025 Pet Assistance, Inc. Emergency Aid Application
This is an emergency aid application questionnaire. If you need emergency help for your pet, please answer these questions to the best of your ability. 
PLEASE READ BEFORE CONTINUING:
  • Pet Assistance, Inc. cannot financially help with a pet's care unless the owner can contribute. 
  • If the pet is young and you do not have money, you may have to surrender your pet to a humane society or local rescue group. They often care for the pet medically, and they will re-home it when it is well.
  • Please send a photo of your pet as well as a written, itemized estimate from your vet to petassistance1973@gmail.com
  • Please note that we will do our best to respond in 12-24 hours. 
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Email *
What is your first name? *
What is your last name?  *
What is your home address?  *
What city do you live in?  *
What is your zip code?  *
What state do you live in? *
What is your phone number? Please include home and cell.  *
What is your pet's name? *
What is your pet's age? *
What is your pet's breed? *
Is your pet male or female? *
Is your pet spayed/neutered? *
What appears to be the problem? *
What are the symptoms?  *
Has the issue been diagnosed by a veterinarian? If "yes", what is the proposed course of treatment? *
What is the prognosis? *
What is the name of your hospital and veterinarian? *
What is the phone number of your veterinarian? *
What is the estimated cost? *
How much have you spent on this problem so far? *
How much more are you able to spend?  *
Please send us a photo of your pet as well as a written, itemized estimate (if you have one) from the vet to petassistance1973@gmail.com. In the email, please include your name and your pet's name. If you do not include your name or your pet's name, we will not respond. To ensure that you understand, please type "yes" below.  *
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