CARES Wellness Financial Assistance Application

Welcome to CARES Community Care.
Tell us a little about you and your companion so we can better understand your needs and connect you with the appropriate CARES resources and services.

Your Contact Information

First Name *

Last Name *

Email *

Gender

Date of Birth *

Agree to media use

Address Line 1

Address Line 2

Phone *

City

State

State/Province

Zip

Postal Code

Country / Region

Emergency Contact *

Emergency Contact Phone *

Emergency Contact Email

Tell us about your little one!

We're so excited to meet you and your furry little buddy!

If you have medical records or important information you'd like the veterinarians to know, please email them to info@caresvetmed.org

Pet's name The maximum length for the field Pet's name is 500 characters.

Pet's breed The maximum length for the field Pet's breed is 500 characters.

Pet's age or date of birth The maximum length for the field Pet's age or date of birth is 500 characters.

Is your pet fixed?

Is there anything else we need to know? Is your pet anxious, scared of loud noises, bites/scratches when scared, likes peanut butter, enjoys salmon treats? Anything! Tell us anything and everything :) The maximum length for the field Is there anything else we need to know? Is your pet anxious, scared of loud noises, bites/scratches when scared, likes peanut butter, enjoys salmon treats? Anything! Tell us anything and everything :) is 500 characters.

After submitting this form, please send the following to info@caresvetmed.org. Your privacy matters to CARES. All information and documents submitted will be treated with care, kept confidential, and handled in accordance with applicable data privacy laws.

1. Government-issued ID (front and back)
2. Two documents from this list:

Recent pay stub(s) — ideally most recent 30 days
Employer statement verifying income
Unemployment benefits statement
Social Security / SSI / SSDI award letter
Veterans benefits statement
Pension or retirement benefit statement
Self-employment income documentation
Most recent tax return
SNAP/EBT benefit documentation
Medicaid eligibility documentation
TANF/cash assistance documentation
Section 8 / Housing Choice Voucher documentation
Public housing documentation
Eviction notice
Foreclosure notice
Written hardship letter
Notice of job loss or termination