Emergency Medical Fund

Emergency Medical Fund Application

Humane Society of St. Lucie County's Emergency Medical Fund provides financial assistance to low-income pet owners facing unexpected and life-threatening medical emergencies with their pets. Please use the form below to apply for assistance from the Emergency Medical Fund.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Please select the following programs you are receiving benefits from (if any):*

WICSSI / SSDITANF (Temporary Assistance for Needy Families)Medicaid / MedicareSection 8 HousingNone of the above
Upload any official document, card, or statement that shows you are receiving one of the benefits from the previous question*

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Upload a copy of your Driver's License / State ID*

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Upload a copy of a recent utility bill (phone, water, etc.)*

Cancelof
Pet Name*
Species*
Provide a detailed description of your pet's medical needs and the estimated cost of care*

Minimum of 250 words0/0
Upload photos of your pet*

By submitting these photos, you grant the Humane Society of St. Lucie County permission to use them in promotional materials to raise funds.
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Upload a copy of the estimate from your veterinarian*

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Should be Empty:

Emergency Medical Fund Application