Laddie's Legacy Program Access Request
Laddie’s Legacy provides financial assistance for urgent veterinary care by veterinary referral only. Please complete the form below to request access to submit referrals on behalf of your clients. Once approved, we’ll send you our program guidelines and the secure referral link for your hospital.
Veterinary Practice Name
*
Primary Contact
First Name
Last Name
Referring Veterinarian
First Name
Last Name
Practice Phone Number
Please enter a valid phone number.
Business Email Address
Must be a hospital or veterinarian e-mail (not personal use unless sole practitioner)
Website
Type of Practice
Please Select
General Practice
Emergency
Urgent Care
Specialty/Referral
Shelter/Rescue Clinic
Low-Cost/Nonprofit Clinic
Mobile/House-Call
Other
Does your practice currently offer financial assistance options to clients?
Yes - In house assistance
Yes - Through outside programs
No
By submitting this form I confirm that I am an authorized representative of the above veterinary practice and request access to submit referrals to Laddie's Legacy. I understand that referral access is for licensed veterinary practices only and that misuse may result in removal.
*
I agree
Submit
Should be Empty: