Financial Assistance Application

Paws for a Cause Animal Aid Network
Financial Assistance Application
YOUR CONTACT INFORMATION
Name*

First NameLast Name
Address*
City/State*
Zipcode*
Email*
example@example.com
How did you hear about us?*
Do you currently have a Veterinarian?

NoYes
NOTE: All cases must be reviewed prior to making an appointment at the Vet centers. Clients must send their medical records to Bouulevard Veterinary Care Center or POcono Peak Veterinary Center. After you case is reviewed, a Paws for a Cause member will contact you.
Phone number of current Veterinarian
Are you willing to use our participating veterinarian

NoYes
Have you received financial assistance from Paws for a Cause or any other animal aid network in the past year? If Yes, please list organization
PLEASE EXPLAIN CARE THAT IS NEEDED FOR ANIMAL LISTED
Please upload recent photo of animal. *ANIMALS FACE MUST BE IN PHOTO* Multiple photos can be submitted.

Cancelof
Pet Name
Age
Sex

MaleFemale
Neutered

YesNo
Date

MonthDayYear
Date
Paws for a Cause Animal Aid Network does not discriminate based on race, color, religion, national origin, age, sex, gender identity, sexual orientation, or disability. We reserve the right to refuse services at our discretion. By signing below, you agree to participate and permit Paws fora Cause Animal Aid Network and the participating vet assigned to this case to use case details (pet name, age, medical issue) and allow photos to be taken during the vet visit for social media and PR purposes. No personal information about the owner will be used. If approved, you agree to pay the veterinarian office any remaining balance that was not covered by Paws for a Cause Animal Aid Network.

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Paws for a Cause Animal Aid Network

Financial Assistance Application

YOUR CONTACT INFORMATION