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Wednesday
Jul112018

To apply for assistance, please answer the following: 

Date: 

 

Pet owner’s name:            

Address:                                                                                                                       

Phone:                                                                          

Email address: 

 

Are you on social security? 

Disability?

Unemployed?    

 

Have you applied for CareCredit.com?   

Were you denied? 

If not, please apply for CareCredit before contacting us. We may ask for proof of denial. 

 

Pet’s name: 

Breed:

Age: 

Microchipped? 

Current on vaccinations? 

 

Do you administer monthly HW preventative to protect pet from mosquitoes that carry heartworms? 

 

How did you acquire this pet? (Adopted, took from friend, bought from breeder etc.)

 

 

Pet’s sex: 

Is pet spayed/neutered?    

If not fixed, why not?

 

Pet’s medical problem and what surgery/treatment is needed: 

 

 

 

What’s the cost of treatment for the animal?

 

At which clinic will the procedure/treatment be done?

 

How much financial aid do you need / (How much money are you short?)

 

Can you donate back Friends of KC Animals if we help? 

 

If so, will you donate to FoKCA online through www.FriendsofKCAnimals.org/donate/or via mail at  

Friends of KC Animals 4741 Central St. Box 348 KCMO 64112?

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