• Finley Fort Foundation Emergency Funds Application

    Application for Veterinary Medical Financial Assistance
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  • Application

    Finley Fort Foundation applications are for future or upcoming treatments
  • Contact Information

  • Format: (000) 000-0000.
  • I/We are applying for assistance for an upcoming medical service.*
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  • Estimated Date for the Upcoming Treatment*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Does your Hospital or Clinic accept payment by:*
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  • Do you have Pet Insurance*
  • Current Employment?*
  • Gross Annual Household Income (estimated before taxes)*
  • How will you (how did you) pay for the procedure(s). Check all that apply*
  • How did you hear about Finley Fort Foundation?*
  • Terms & Conditions:

     

    Due to increased applications, responses could take up to 5 business days.

    By submitting this application, the applicant gives Finley Fort Foundation permission to contact the veterinary clinic or hospital on the applicant's behalf to verify the upcoming treatment and to request documentation, including the updated or current proposed treatment plan and/or invoice.

    This application is for assistance with upcoming or in-progress veterinary treatment only and is not a request for reimbursement. Applications submitted for treatment that has already been completed and paid in full, or to reimburse existing balances, CareCredit accounts, loans, credit cards, or other financial obligations, are not eligible.

    All funds must be applied for by the pet's owner and not by a third party.

    If approved, FFF will pledge the awarded amount and pay the veterinary hospital or clinic directly via mailed check or secure electronic payment. Please verify with your clinic that this is acceptable prior to submitting your application. FFF does not process payments over the phone or in person, and does not issue payments directly to individuals.

    Any unused portion of approved funds must be returned to FFF promptly. If the applicant has pet insurance and receives a reimbursement for the same treatment funded by FFF, the lesser of the two amounts must be returned to FFF so that combined payments do not exceed the applicant's actual out-of-pocket cost of treatment.

    The recipient agrees to provide any documentation needed for FFF accounting or tax purposes. The medical provider must be able to supply a receipt or invoice directly to FFF upon request.

    All recipients of FFF funds agree to provide photos, videos, or updates upon request that may be used on, but not limited to, FFF social media accounts, finleyfortfoundation.org, or other marketing materials.

    We kindly ask for your support in raising awareness of FFF's mission and promoting fundraising efforts so FFF can help more of Hawaii's pets receive the care they need.

    Finley Fort Foundation reserves the right to refuse or decline any application, or reverse any approval or pledge, if it determines that any information submitted was misleading.

    Misrepresentation of any information in this application, including failure to disclose insurance reimbursements or failure to return unused funds, may result in disqualification from current and future FFF programs.

     

  • Declined Application

    We’re sorry, but we cannot provide reimbursements for completed medical procedures. If you have unpaid invoices for upcoming or ongoing treatments, please reapply for assistance.
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