Helping Paws

Formed in 2019, the HELPING PAWS FUND is based on the belief that family pets should have access to veterinary care regardless of their owner’s financial situation. This fund seeks to aid eligible pet owners by giving charitable gifts which can offset the financial burden of emergency care when the pet has a positive prognosis.

Owner Name

Street Address

City/State

Telephone (Main)

Telephone (Mobile)

E-mail

Social Security Number

Driver's License

Pet's Name

Species

Color

M/F/Spayed/Neutered

Breed

Age

Have you applied for care credit

Yes No

If Y Date

Approved or Denied

Approval Amount

If denied please submit denial declaration page.

Helping Paws Grant Amount Requested

Veterinarian

Veterinarian Address & Telephone

Diagnosis

Prognosis

I attest that all information I have provided in this form is accurate and complete. I give consent for all the above mentioned care at the treating doctors’ discretion. I fully understand that donation of this grant in no way causes Helping Paws to assume any liability for my pet and does not ensure outcome of any treatment provided. I understand that any photographs or documented care may be used for purposes of promotion and fundraising.

Date