Pets2TheVet
For assistance with the cost of non-routine veterinary care, please answer each question completely and honestly.
How did you hear about us? *
Your answer
First Name *
Your answer
Last Name *
Your answer
Email Address *
Your answer
Address *
Your answer
Phone Number (Primary) *
Your answer
Pet Species *
Name of Pet *
Your answer
Gender of Pet *
Approximate Age *
Is Pet Spayed or Neutered? *
Is Pet up to date on vaccinations? *
Does Pet have a regular veterinarian? *
If yes, please provide name, address, phone number of veterinarian
Your answer
How long have you had Pet? *
Your answer
How did you acquire Pet? *
Your answer
Pet is an *
If Pet is kept outside please elaborate on its living conditions.
Where does it sleep, when is it socialized, how is it kept safe, why is it kept outdoors
Your answer
How Pet already had a diagnosis? If so, please explain. *
Your answer
Has a course of treatment been recommended for Pet? *
Your answer
Estimated cost of treatment
Your answer
How much money are you prepared to contribute? *
Your answer
Do you have funding from other sources? *
Credit cards, family members, loans, etc
If yes, how much? *
Your answer
Have you applied to other groups for assistance? *
If yes, List groups here *
Your answer
Have any offered assistance? *
If yes, how much? *
Your answer
Have you applied for Care Credit? *
Care Credit status? *
If yes, how much? *
Your answer
Total number of adults living in your home. *
Your answer
Total number of children living in your home. *
Your answer
I agree to provide the following information before an agreement for assistance is reached. *
Required
I agree to the following *
Required
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