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Medical Assistance Application for Veterinary Care
As resources allow, C.A.R.E.4Paws assists low-income pet families in the counties of Santa Barbara and San Luis Obispo with veterinary care. Applying for CareCredit and ScratchPay are required steps in the application process. We also ask that any adults in the home/family also apply for CareCredit and ScratchPay. Note, that our mobile clinic is not a full-service or emergency veterinary hospital.
**Is your household not low income?
As our clinic schedule allows, we can assist pet families who do not require financial assistance. We can do so at a higher cost per service under special circumstances. For example, if your regular veterinarian cannot see your pet(s), or you have difficulty scheduling a timely appointment at any local, full-service veterinary clinic. Please let us know your pet's treatment needs and we will share a separate service price list and discuss the next steps. You do not have to upload documents at the end.
We require a separate form for each pet.
Please note that per our organization's spay/neuter policy, we require that any unaltered pet that will be put under anesthesia during his/her treatment in C.A.R.E.4Paws' mobile clinics gets (altered) spayed or neutered during the procedure.
Owner's first and last name
*
First name
Last name
Address (Unhoused clients, please enter city and zip code.)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you live in Oceano? You are required to provide proof of residence to qualify for our Access to Care program.
*
Yes
No
Are you willing to travel?
Yes
No
Phone number
*
Please enter a valid phone number.
Email
*
example@example.com
Pet's name
*
Pet's age (month/year)
*
Please include how old your pet is in months or years.
Do you have a dog or a cat?
*
Dog
Cat
Is your cat:
*
Indoor only
Indoor/outdoor
What breed is your pet?
*
Pet's weight
*
Is your pet a male or a female?
*
Male
Female
Is your pet spayed or neutered?
*
Yes
No
If not, are you willing to spay or neuter your pet? Why, or why not?
*
Would you need financial assistance with the spay or neuter?
*
Yes
No
What medical issue(s) is your pet experiencing and how long has it been present? Please be as detailed as possible.
*
Have we assisted your pet within the last 12 months?
*
Yes
No
Has your pet been diagnosed with a medical issue?
*
Yes
No
If so, please request your pet's complete records, including an estimate, and forward a copy to info@care4paws.org.
*
I agree
To help us better assess your pet’s needs beyond the primary concern, please provide us with the following information. Does your pet have:
Vomiting
Diarrhea
Coughing
Sneezing
If yes, please share how long these symptoms have been occurring.
Has your pet been lethargic?
*
Yes
No
If yes, please provide more details.
Is your pet drinking normally?
*
Yes
No
If not, please provide more details.
Is your pet eating normally?
*
Yes
No
If not, please provide more details.
Is your pet urinating regularly?
*
Yes
No
If not, please provide more details.
Are your pet’s vaccines current? (Rabies, DHPP/Distemper/Parvo, FVRCP-Feline Distemper)
*
Yes
No
Is your pet on any medications?
*
Yes
No
If so, what kind? Include flea/tick treatments and heartworm preventatives.
*
Would you like us to know anything else about your pet?
Preferred language
*
English
Spanish
Do you require financial assistance?
*
I require assistance and have proof of low-income.
I am not low-income.
Briefly describe your need for financial assistance.
*
To expand options and resources for your pet's care, applying for CareCredit and ScratchPay is a required step in the C.A.R.E.4Paws application process for assistance.
*
I agree
How much can you contribute toward your pet's vet visit and care?
*
Have you applied for CareCredit? (unrelated to C.A.R.E.4Paws)
*
Yes
No
If yes, how much did CareCredit authorize?
*
Have you applied for ScratchPay? (unrelated to C.A.R.E.4Paws)
*
Yes
No
If yes, how much did ScratchPay authorize?
*
C.A.R.E.4Paws accepts clients residing in Santa Barbara County and San Luis Obispo County who can provide current proof of low income. Please select your qualifying reason below and provide a copy that includes your name and address. Do not submit documents displaying banking information, passport numbers, Social Security numbers, or other government ID numbers.
*
Proof of low-income, pay stub
Unemployment
Social Security income
SSI Disability
Food Stamps
Medicare/Medicaid/Medi-Cal
VA Disability
CalWORKS
WIC
CalFRESH
BIA General Assistance
Section 8
Please upload at least one qualifying document from the list above that includes your name and address. Required for all applicants!
*
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Upload only if you have two files.
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Proof of residence in Oceano is required. Please upload at least one document with your name and address visible. This can be a utility bill or part of a rental agreement, for example. Required for all applicants!
*
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C.A.R.E.4Paws accepts clients residing in Oceano who can show proof of financial need. Please select your qualifying reason below and provide a copy that includes your name and address. Do not submit documents displaying banking information, passport numbers, Social Security numbers or other government ID numbers.
*
Proof of low-income, pay stub
Unemployment
Social Security income
SSI Disability
Food Stamps
Medicare/Medicaid/Medi-Cal
VA Disability
CalWORKS
WIC
CalFRESH
BIA General Assistance
Section 8
Please upload at least one qualifying document with your name visible from the list above. Required for all applicants!
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
PLEASE NOTE:
Our mobile clinic is not a full-service or emergency veterinary hospital and we have limited clinic and office staff working weekends and holidays. We do our best to get back to clients quickly.
If your pet is in distress and suffering, please contact your veterinarian or emergency pet clinic. It is an owner’s responsibility to seek medical care for a sick or injured animal.
You will receive an immediate confirmation of all the information you submitted.
I agree
I agree
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