Pet Medical Assistance | Circle of Friends Humane Society

We are partnered with MYRA Foundation and Banfield Foundation to help offer some assistance with Veterinarian costs when an unexpected cost arises and an owner is struggling to afford to pay for Veterinarian expenses.

Emergency medical assistance

Our Companion Animal Program is available to pet owners in financial need experiencing emergency medical expenses with their pets.

Spay/neuter assistance

Spay/neuter certificates are available to members of the general public experiencing financial need.

Fill out the form below to request assistance. Please remember that filling out this form does not guarantee assistance.

Type of Assistance Needed
- Medical Assistance
- Spay/Neuter Assistance
Name

First

Last
Date
Address

Street Address

City

State / Province / Region

ZIP / Postal Code

Country
Phone
Email
Animal Name*
Species*
Sex of the Animal*
Age of the Animal*
Breed of the Animal*
Reason the animal needs to be seen by a Veterinarian
What is an estimated total for this visit?*
How much assistance do you need towards the estimated cost?*
If approved which Vet clinic will you be using?*
Vouchers are good for 30 days from the date of issue. Do you agree to use it within that time frame?*
How many people live in your household?*
Do you qualify for:*
I am on unemployment and/or am the sole supporter for my family. There are no other working adults in my household.*
I am on unemployment and/or am the sole supporter for my family. There are no other working adults in my household.
I am in a low income group:*
I am a full time active military and/or sole income earner for my household:
If you are not part of any of the circumstances above, but have had personal circumstances please explain below:*
In order to provide assistance, we are looking for your testimonial–this helps us continue receiving funds for animals in need.*
Please upload a photo of the animal you are requesting assistance for:
Can we use the photo of your animal for grant reporting?*
- Yes
- No
I release that Circle of Friends can share all the information above. Please print first and last name:*
Please sign releasing that Circle of Friends can use the above information. Thank you*
Comments

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