Get Help Application

PLEASE DO NOT SHARE THIS APPLICATION FORM UNLESS INSTRUCTED TO BY PROJECT STREET VET STAFF. APPLICATION FORMS ARE SENT TO PRE-QUALIFIED PET PARENTS ONLY:

Are you currently experiencing homelessness and/or housing vulnerability? Project Street Vet may be able to assist qualified pet parents with their pet’s veterinary care. Whether you are a pet parent we have seen in the past or a new referral, Project Street Vet staff work directly with pet parents to understand what a pet needs and potentially fund for treatments directly to veterinary hospitals, coordinate visits, or refer to other amazing resources that may be able to help.

Project Street Vet mainly assists pet parents with treatments including, but not limited to: exams, minor care, spay, neuter, limited diagnostics, and other needed routine care. Other treatments will be considered on a case-by-case basis pending prognosis of pet and funding availability. Project Street Vet does not fund for services already performed or resuscitation for pets, and are mainly able to assist pets in California at this time. If Project Street Vet is funding a surgery for your pet, spay/neuter will be done at time of surgery.

Please fill out the quick application form below, and our team will be in touch with you shortly. If you have any questions, please feel free to email val@projectstreetvet.org. Application submission does not guarantee approval.

Your Name

First Name

Last Name

Address or Location

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Annual Income

Employer

Are you receiving any financial assistance? If so please explain.

Are you a veteran?

Are you a senior?

Can you tell us about your situation and why you are experiencing financial hardship?

Do you have any funds to contribute to your pet's care, and if so how much?

Pet's Name

First Name

Last Name

Pet's Breed

Pet's Age

Is your pet spayed or neutered?

If your pet is not spayed or neutered, it is something Project Street Vet recommends to improve your pet's health and avoid pet overpopulation. It is something we can help with if you are interested. Are you interested in getting your pet spayed or neutered?

Is your pet current on vaccines?

Do you have a normal vet hospital? If so, what is the name of the hospital?

What medical issues is your pet currently experiencing?

Can you tell us about your relationship with your pet?

Is there anything else you and your pet need help with?

How did you hear about PSV?

Do you have access to transportation?

By submitting this application, I understand that Project Street Vet (PSV) is not responsible for the treatment and/or result of any veterinary services provided and waive any and all claims for liability against PSV, and that PSV hereby reserves the right to deny assistance to anyone for any reason. I understand that PSV is not financially responsible for charges incurred at the treating veterinary hospital prior to the submission of this application. I understand that if I am approved for funding, I am not automatically approved for any further assistance. I understand that if a surgery is being funded by PSV that my pet(s) will be sterilized at the time of surgery if it is deemed safe to do so by the treating veterinarian. I authorize PSV to use my and/or my pet’s photographs, videos, and any information relating to the payment of funds pursuant to this application for any purpose. I understand that Project Street Vet may need and request medical records of my pet(s) to determine program eligibility.

Please type your full name.

Get Help Application

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