Vet Care Assistant

INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.

YOUR Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Email

example@example.com

What are you requesting assistance with?

How much $ are you able to contribute to the total bill?

Pet's name

Breed AND age

Sex

MaleFemale

Weight

If your dog is a female, is she pregnant or has she been exposed to male dogs? If yes, how far along is she? FAILURE TO DISCLOSE COULD RESULT IN AN ADDED CHARGE YOU WILL BE RESPONSIBLE FOR.

Is your dog current on vaccinations?

YesNo

Is your dog current on flea/tick and heartworm prevention?

YesNo

What day would you like to come?

BY SIGNING BELOW, YOU AGREE TO THE FOLLOWING:

*This service is for low or fixed income families. You may be required to provide proof of income.

*You are 18 years or older.

*Paws Up Rescue, LLC is providing vet care to family pet owners only (no breeder, no rescuers).

*Proof of current rabies vaccination must be provided. If your dog does not have a current rabies vaccination, one will be provided at no extra cost to you.

*You will be responsible for a portion of the cost and this must be paid at the time of drop off. The amount will be determined once we receive your form. For spay/neuter assistance only, it will be $50.

*You are the legal owner of above listed dog and have proof of ownership, all vet paperwork will be entered in the name on this form.

*To bring the animal to the vet at the scheduled time. Missed appointments may not be rescheduled.

*To provide after-care required for any surgeries or medical treatment.

*To give all medications as advised by vet.

*To the follow up vet visits required by vet and are able to transport them there.

*This contract is for the requested assistance only, not for on going vet care unless otherwise noted by Paws Up Rescue LLC staff.

*By signing below, you are fully aware that your pet will be having surgery and vaccinated, this comes with risks, not limited to but including death. You agree to hold harmless Paws Up Rescue LLC, Red Oak Vet Clinic and any staff affiliated with either business.

Signature