Financial Assistance Request (INDIANA)

Voucher Code:
Total After Voucher (per cat)
Amount Discounted (per cat)
Additional Info
Financial Assistance Application

(FOR INDIANA RESIDENTS)

Please note that some of our assistance programs are subject to income requirements. To ensure that you are considered for all available funding sources, please answer all questions truthfully. We strongly advise against allowing financial limitations to prevent you from seeking medical attention for your cat. Let's work together to find a solution.

Important Note:

This form does NOT register you for an appointment slot. If you are approved for financial assistance, you WILL need to still complete the regular clinic registration form on our website. The registration form is located at this link: Clinic Registration

*ASSISTANCE FUNDING IS ONLY FOR OUR OWN CLINICS*

Our funding is only applicable for our Public Vet clinics. Please do not apply for assistance if you are not intending to come to one of our clinics.

Your Name:*

First NameLast Name
Your Email:*

Confirmation Emailexample@example.com
Phone Number:*
Please enter a valid phone number.
What state do you live in?*
What INDIANA county do you live in?*
Do you live in Terre Haute city limits?*

YesNo
Do you live in Gary city limits?*

YesNo
What Indiana COUNTY do you live in?*
(Some counties have spay/neuter assistance funds)
This application is only available for INDIANA RESIDENTS.

If you are applying for California, please visit our website and select the 'California Financial Assistance Form' at this link: Financial Aid
Do you already have a Pet Friendly Services SNAP / CCP voucher or voucher covering TOTAL surgery cost?*

YESNO
Please tell us which voucher you already have, AND how much the voucher covers:*
Ex: SNAP voucher - $XX towards surgery cost
Important Note:

By selecting 'YES' above, you are stating that you have received an animal surgery voucher certificate. The Pet Friendly Services SNAP program is separate from the SNAP food assistance program. Please do not select 'YES' if you receive SNAP food assistance but do not have a surgery voucher. Thank you

We would like to remind you that we can safely spay/neuter kittens as young as 6 weeks old, regardless of their reproductive stage. This includes pregnant cats, nursing cats, and cats that have recently given birth. If the mother is still nursing, kindly bring all the kittens along with her to the appointment so that we can provide them with the necessary veterinary care.
How many cats do you want to bring to this clinic?*
Select 'Other' if bringing more than 6 cats
Please specify the number of cats you want to bring:*
Are any of the cats not owned?*

Yes: Stray, Feral, or AbandonedNo: They are mineNo: They belong to someone else
Please provide us with the names and ages of the cats that you plan to bring:*

The cost for our standard service is $100 per cat, which covers the examination, surgery, pain medication, and essential services. We kindly request that you inform us of the amount you are able to afford per cat. It is essential that you are upfront about your financial capacity, as we require this information to determine if we can provide financial assistance to you. We encourage you to be responsible and disclose the maximum amount you can afford, as this will assist us in seeking the appropriate aid. Failure to provide this information may hinder our ability to assist you adequately.
How much can you afford to pay per cat?*
Please give us your best estimate
We kindly request that you provide us with details about your income. Please be honest in your response, as your income does not disqualify you from receiving assistance. It is important to note that this information will be kept confidential and only used to facilitate assistance for your cats.*
Have you previously visited a veterinarian? If so, which veterinarian did you visit? Please inform us of the local veterinarian you contacted for spay/neuter services and their respective charges. In the event that you have not visited a veterinarian before, kindly let us know.*

Your personal story is often the most powerful motivator for donations. We kindly request that you share your circumstances with us and how our assistance would alleviate any difficulties in your life.*
Are any of your cats being re-homed, or are any of your cats in need of new homes? Please explain. If there are new owners, please provide their information for the medical records.*
Have any of your cats had litters before? If so, what did you do with the kittens? Please explain.*
Please click Submit and we will review your submission.

If your voucher qualifies for 100% coverage of the surgery cost, we will provide you with a coupon code to remove the $10 appointment pre-pay requirement.
Should be Empty:

Please apply at least 3 days PRIOR to the clinic you are intending to register for. We cannot guarantee a response in time if you apply less than 3 days before a specific clinic.