Request Support for my pet

Name*

First NameLast Name

E-mail*

Phone Number*

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Urgency Level*

Today - My pet is in critical conditionIn the next 48 hours - General CareThis weekNot Urgent but need assistance with routine things

How would you like to be contacted?*

Please call meText message is fineBy e-mailAny of the above

Need Assistance with my:*

Name of Pet(s)

Describe What you are needing help with and any information to support your case. *

Supporting Picture

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Supporting Pictures

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Vet records related to the request

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Drivers License*

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Disclaimer: By signing this form you agree that Apollo Support & Rescue has the authority to make medical decisions for your pet, to include treatment options and/or humane euthanisia if the vets deem the animal is suffering and unable to be saved. You agree to not hold Apollo Support & Rescue liable for the outcome. We will do our absolute best to give your animal the care it needs, but depending on the severity of the issue the pet may have long term medical issues, amputations, or not make it.

Signature *

Animal Support Request