ACT Pet Crisis Support Application
This form is to be completed by vet clinics only. If you are a pet owner, please visit a vet and ask them to apply on your behalf after they have seen your pet. Vet clinics, please ensure that you have exhausted other options such as VetPay prior to completing the form - even if the owner thinks it is unlikely they will be approved for VetPay, please ask them to complete an application (they may be able to make some contribution to their pet's care).
Name of person completing this form
Date of application
Contact email address for treating vet clinic
Email address of client
What is the financial situation of the pet owner?
Signalment for pet (breed, age, sex)
How much do you want the fund to contribute?
Condition needing treatment and expected outcome of treatment
When does the procedure/treatment need to take place? If the pet requires immediate first aid, please administer this up to the value of $250, until we approve your application.
Please post a quick summary of the situation that we can post on social media (details about what the pet means to the owner and what it will mean to them if we help are particularly social-media friendly).
Has the owner applied for VetPay?
Yes, but they were declined or VetPay can't cover the entire amount
No (please do this first!)
Is the owner happy to have their pet's picture shared on social media?
Please upload a picture we can use on social media here, email to firstname.lastname@example.org or text to 0430926060. Cute pictures of pets, particularly with people in the photo help us to fundraise so we can help more pets.
Any additional information can be included here.
Should be Empty: