Pet Assistance, Inc.........helping people and their pets since 1973
Emergency Aid Application Questionnaire
phone numbers (home and cell
What appears to be the problem?
What are the symptoms?
What is veterinarian's diagnosis?
What is the prognosis?
What is the proposed course of treatment?
What is the estimate cost?
How much have you spent on THIS problem?
How much are you prepared to spend?
If you have a written estimate for the proposed treatment or procedure, please send us a copy.
Name of your Animal Hospital
Phone Number of Hospital
Please upload a photo of your pet
Pet Assistance cannot financially help with a pet's care unless the owner can contribute.