Apply for Assistance

The DaisyCares Veterinary Care program has a limited monthly grant capacity and is subject to availability of funds.

Pet Owner Information

1. Name of Pet Owner(required)
2. Street Address(required)
3. City(required)
4. State(required)
5. Zip Code(required)
6. Phone
7. Email Address(valid email required)
8. Are you the legal owner of the pet described below?
9. yes no
10. If no, please explain
11. How did you hear about us?

Veterinary Information

1. (If your pet has not visited a Veterinary for this medical problem, please fill in N/A in each space under Veterinary Information.)
2. Name(required)
3. Street Address(required)
4. City(required)
5. State(required)
6. Zip(required)
7. Phone(required)
8. Fax(required)
9. Email
10. Medical License Number
11. EIN

Pet's Medical Information

1. Name of Pet
2. Type of Pet
3. canine feline
4. Age of Pet(required)
5. Description of Diagnosis, Medical Treatment, Symptoms or Injury(required)
6. Is the medical Treatment urgent?
7. yes no
8. Is follow-up care required?
9. yes no
10. If so, will you be able to pay for the cost of the follow-up care?
11. yes no
12. What is the estimated total cost of treatment?
    (if the cost is unknown, please insert N/A)(required)
13. How much are you able to personally contribute?(required)
14. How much of the cost of the care are you asking DaisyCares to contribute?
    (if the cost is unknown, please insert N/A)(required)

Financial Hardship

1. Describe your financial hardship: (required)
2. (send to DaisyCares by email or mail, or provide a copy to the treating Veterinarian (with permission to deliver to DaisyCares), any of the following information that supports your financial hardship: a copy of your latest check stub; a copy of your current unemployment benefits; a copy of your latest tax return; a copy of your latest bank statement; a copy of any SSI benefits; a copy of an unemployment benefit letter; a copy of your latest W-2 or 1099 from a current employer; evidence that you are residing at a homeless shelter; or any other reasonable supporting evidence of financial inability for consideration by DaisyCares on a case by case basis). Your application will not be considered complete until evidence of hardship is provided to DaisyCares.
   
   I attest as follows: All of the information I have provided to DaisyCares (or caused to be provided to DaisyCares) is true, complete and correct. I have reviewed the Qualification Criteria, and satisfy the requirements for qualification set forth therein. I am asking DaisyCares for a grant of in the amount set forth above, to be paid directly to my Veterinarian listed above or a Veterinarian referred to me by DaisyCares. I agree to pay the remainder of the cost of the medical care to the Veterinarian listed above or the Veterinarian referred to me by DaisyCares, as a condition to the grant. I give my consent for the above mentioned medical care. I understand that DaisyCares assumes no liability and makes no assurance as to the appropriateness, qualify or outcome of any medical diagnosis, treatment, products or services. I further agree that DaisyCares has no agency relationship with the treating Veterinarian, whether or not referred to me by DaisyCares. I consent to allow DaisyCares the use of any pictures, and description of medical care for the purposes of promotion and fundraising.
   
   Application will only be processed when you click “Submit Application” and provide your evidence of hardship as requested above. No applications will be processed via mail or fax, unless waived by DaisyCares in its sole discretion.

 

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Photo Gallery

Photos of the lives DaisyCares has impacted through veterinary care services.

In Honor/Memory Of

Donations made in honor or memory of beloved four-legged pals.

Other Pet Resources

A listing of other pet resources, including low cost veterinary care, in the San Antonio area.

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