apply for assistance | Brown Dog Foundation

PLEASE READ BEFORE PROCEEDING WITH THE SURVEY
This is Step 1 of a 5 Step Process
Please refer to the Approval Process page for details

*** If you believe that your pet's life is in immediate danger, you should apply here, but seek immediate assistance from a licensed Veterinarian. We will consider assisting in cases where treatment has already occurred IF the pet's life was truly at risk, provided you complete this questionnaire within 7 days of the injury/illness.

Thank you for contacting Brown Dog Foundation. We are an organization dedicated to helping families who find themselves in a temporary financial crisis at the same time their pet requires life-saving treatment or life-sustaining medications. We provide assistance to families who normally live above the poverty line, but have experienced a financial setback - unemployment, unexpected and major medical bills, loss of home, etc. We are designed as a one-time benefit in most situations. We are committed to ensuring we help maintain and strengthen the bond between pets and their families during times of unexpected financial crisis. As a result, if your application is approved and funded, we will require very detailed information and long-term commitments.

Treatments we consider funding
Surgery related to correctible immobility of pet when the life fo the pet is in danger
Exploratory surgery when the life of the pet is in danger
Treatable cancers (Stages I-III)
Treatable neurological disorders
Diagnosis and initial treatment of on-going conditions/diseases (except cancer)
Treatable organ disorders (organ must not be in failure)
Limb removal (when the animal's life is truly at-risk)
Palliative Treatment for End of Life cases

Please answer the questions below. Your answers will be reviewed by a Case Review Manager. Within 24-hours, the Case Review Manager will advise if you meet our Pre-Qualification Guidelines.

If your case meets our Pre-Qualification Guidelines, you will receive our Application for Assistance attached to that email.

The application will take approximately 2-3 hours to complete and gather required documents (we require proof of pet ownership, proof of vaccinations, proof of income and proof of hardship).

We will review your application and request information from your Veterinarian.

Click here to view the Federal Poverty Level Guidelines chart.

How did you hear about us?

Full Name

Email Address

Street Address

City:

In what state do you reside?

ZIP Code

What type of assistance are you requesting?

How old is your pet (whole numbers only)?

How long have you owned your pet (whole numbers only)?

Is the injury/illness life-threatening to your pet, or are you being forced to consider euthanasia, surrender or opening a credit account that you cannot pay for? If your pet will stay sick or die without treatment/medications, then the condition is life-threatening.

YesNo

Please explain what is wrong with your pet, including date of initial onset and treatment received thus far.

Typically, we require the families we assist to pay 25% of the costs for treatment. How much are you willing and able to pay at the time services are rendered?

What is the cost of the proposed treatment?

You may need to refer to the Federal Poverty Guidelines chart to answer the next few questions.

Is your total household income normally above poverty level? If you are unsure, please click on the link above "Federal Poverty Guidelines".

YesNo

What is your normal, total household income? If you are unemployed or have incurred a loss of income, please tell us what your income was prior to the loss.

Including yourself, how many people are cared for on the income reported?

If your normal income is above 200% of poverty, we can still consider your case if you can you prove temporary, financial hardship with appropriate documentation (ie. job loss, major illness in the family, unexpected major bills). Are you in this situation and can you prove it?

YesNo

If you are claiming temporary hardship, please describe it here? Otherwise, enter NA.

Please select the statement that applies to your normal financial situation:

Do you own this animal, and is he/she your family pet (not a breed dog, show dog or fight dog)?

YesNo

How many pet dogs and cats do you own?

Do you breed any of your dogs or cats?

YesNo

In what year did your pet receive his/her last rabies vaccination?

Is your pet spayed or neutered?

YesNo

Can you prove ownership or adoption of the pet?

YesNo

Pre-Qualification Survey