Application for Veterinary Care Assistance Form

As proud participants in the Veterinary Care Foundation’s Charitable Fund, we at Lifetime Pet Center of New Richmond are committed to helping families in need access the veterinary care their pets deserve. If you require assistance paying for veterinary care, we encourage you to complete the form below to apply to this program.

Get Started

How to Apply

Fill out all required fields as accurately as possible. Once your application is submitted, a member of our team will review it and contact you regarding eligibility.

Submit Your Form

Use the form below to provide the necessary information for your application. Be sure to include all details to help us process your request efficiently.

Client Name(Required)

First Last

Physical Address(Required)

Street Address Address Line 2 City State ZIP Code

Cell Phone Number(Required)

Email(Required)

Pet's Name(Required)

Pet's Age(Required)

In Years

Species(Required)

Dog

Cat

Please describe the concerns you have regarding the health of your pet:(Required)

Why are you applying for financial assistance for your pet? (Choose all that apply)(Required)

Good Samaritan case

Pet owner in financial crisis

Care for police/fire and service animals

Pet owner in crisis (non-financial)

Funding for pets harmed or displaced due to local disaster (such as weather, fire, etc)

Other

If you chose the other option above, please give a brief explanation regarding your request of financial assistance.(Required)

Please describe your situation as referenced above with as much detail as you can provide.(Required)

What is your average annual household income?(Required)

By signing below, you acknowledge and accept the following:

Submitting this application does NOT guarantee that funds will be awarded.
Prepayment of the examination fee is required to be eligible for funding.
The client is responsible for any costs not covered by the grant. Prepayment of these additional costs is required before the pet can receive treatment or grant funding.
If awarded, the grant is for one-time use only and does not cover ongoing care. The client will be responsible for any future care unless otherwise approved.
Recently adopted or purchased puppies or kittens are not eligible for grant funding. Please contact Pets in Need of Greater Cincinnati for low-cost wellness care for your puppy or kitten, or UCAN for low-cost spay/neuter services.

Date of Application(Required)

Signature(Required)

Application for Veterinary Care Assistance Form

How to Apply

Submit Your Form

Contact Us

Contact

Location

Hours

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