Voucher Code:
Total After Voucher (per cat)
Amount Discounted (per cat)
Additional Info
Financial Assistance Request (INDIANA)
Kindly provide us with the following information so that we can help you get the necessary assistance. 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.
Your Name:
*
First Name
Last Name
Your Email:
*
Confirmation Email
example@example.com
Phone Number:
*
Please enter a valid phone number.
What state do you live in?
*
Please Select
AL
AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
What Indiana COUNTY do you live in?
*
(Some counties have spay/neuter assistance funds)
Do you already have a Pet Friendly Services SNAP / CCP voucher or voucher covering TOTAL surgery cost?
*
YES
NO
Please tell us which voucher you already have, AND how much the voucher covers:
*
Ex: SNAP voucher - $XX towards surgery cost
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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.
If financial aid is a constraint for you, please refrain from booking your appointment until we review your application. The $10 appointment deposit is non-refundable
You MUST specify the LOCATION/DATE for a SCHEDULED clinic from our website that you are intending to register for.
We can ONLY provide assistance if we know WHICH particular clinic / date you wish to attend, since our funding can vary per clinic. We cannot review applications that do not specify a currently scheduled clinic location / date.
Have you already signed up online for one of our clinics?
*
Please Select
Yes
No
Which of our clinic location are you signed up OR intending to sign up for?
*
Example: Warsaw, IN
What is the date for this clinic?
*
-
Month
-
Day
Year
Date
How many animals do you own and/or feed currently?
*
(Including feral cats)
Are you requesting help for animals that are not yours?
*
Please Select
Yes
No
Please explain the situation for the animals that are not yours:
*
Do you house/care for all of the animals that you feed/own? Please explain:
*
(Often more funding options are available to multi-pet homes)
Please select all programs below that you currently receive. If none are applicable, please select 'None of the above'.
*
Energy Assistance Program
Food Stamps (Hoosier Works)
HIP (Healthy Indiana Plan)
Major VA Disability
Medicaid (NOT Medicare)
Public School Free Lunch Program
Section 8 Housing
Social Security Disability (SSD - NOT SSRI)
Supplemental Security Income (SSI)
Special Supplemental Nutrition Program for Women, Infants, & Children (WIC)
None of the above
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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?
*
Please Select
1
2
3
4
5
6
Other
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 Abandoned
No: They are mine
No: They belong to someone else
Please provide us with the names and ages of the cats that you plan to bring:
*
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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.
*
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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.
Submit
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