Veterinary Assistance

Apply for Veterinary Assistance

LEADSRQ provides financial assistance grants to family-owned pets in need of lifesaving emergency or specialty veterinary care whose caregivers cannot afford the full cost of treatment.

Our programs are designed to help with the treatment of emergency and specialty medical conditions where the pet would otherwise suffer, be euthanized, or relinquished without proper veterinary care.

Applications for assistance will be considered if:

Your pet needs emergency or specialty veterinary care
Your pet has already been seen by a licensed veterinarian
The veterinarian has determined your pet has a good prognosis with treatment
You can show documentation of financial need
And the treatment plan has not yet been paid as we do not reimburse for any payments already made

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LEADSRQ Application

LEADSRQ provides financial assistance grants to family-owned pets in need of lifesaving emergency or specialty veterinary care whose caregivers cannot afford the full cost of treatment. This program is designed to help with the treatment of emergency and specialty medical conditions where the pet would otherwise suffer, be euthanized, or be relinquished without proper veterinary care. If your pet is in need of immediate care, where any delay will put the animal at risk, it is your responsibility and duty to seek care for the pet immediately. There is no guarantee that the fund will provide financial assistance so please do not delay care for your pet while waiting for a response on your application. Grants are not guaranteed, and will not exceed $1000.00 per pet, per household. Due to the large volume of applications we receive, the program is unable to help everyone who applies. Before applying, you must have a clear diagnosis, specific treatment plan in place, and an estimate of the cost of care from a veterinarian.

This is ONE of SEVEN signatures. Please sign and go onto the next page.(Required)

I have read the above information and agree to the terms of the application.

Name(Required)

First Last

To Begin Your Application

Read through each section in its entirety before proceeding. You will need access to a computer and the capability to upload documents to complete the application. Incomplete applications will not qualify for assistance.

Before You Start

You will need to have the following items available to complete the online application. Once you have started the online application, you will not be able to return at a later time to complete it.

COLLECT THE FOLLOWING REQUIRED DOCUMENTATION

FINANCIAL information:
1. Proof of Income (for ALL working adults in the household)
* This can be a copy of check stubs, unemployment benefits, disability benefits, etc. for all working adults in the household where the pet resides.
* The proof of income must be recent, so only tax forms from six (6) months prior will apply.
2. Proof of application for Care Credit or Scratch Pay showing denial for funding, or being approved for an amount that is less than the remaining cost of treatment needed.
3. Documentation of any payments already made to the treating veterinary clinic towards the cost of care, including the cost of the initial exam and any diagnostics prior to treatment, with a balance of the amount needed to complete the pet’s treatment plan.
4. List of additional resources of which the applicant has already applied (ie setting up a gofundme page, applying for other nonprofit organizations’ assistance, help from family/ friends, payment plans set up, etc.)
CLINICAL Information:
1. Copy of a written cost estimate for the needed procedures and/or treatment with a written prognosis as determined by a licensed veterinary professional at the treating facility.
2. A detailed statement of the pet’s clinical condition. Any abuse and/or neglect-related requests will automatically be denied as it is our top priority to ensure safe, responsible pet ownership.

This is TWO of SEVEN signatures. Please sign and go onto the next page.(Required)

I have read the above information and agree to the terms of the application.

Name(Required)

First Last

ELIGIBILITY GUIDELINES

Assistance is only provided to family-owned pets. Grants are only awarded for one pet, per household, per lifetime. Pet must have a life-threatening injury or illness that requires urgent and specific treatment to qualify. Assistance is only provided for emergency and specialty veterinary care. Pet must have already received a diagnosis and treatment plan from a veterinarian with a good or favorable outcome/prognosis. Both the applicant and the animal must live in the United States.

WHAT WE DO NOT FUND

1. Office exams or diagnostic testing to determine pet’s prognosis
2. Basic veterinary care, food or basic pet supplies (deworming, grooming, flea treatments)
3. Routine veterinary care: annual exams, checkups, spay/neuter
4. Vaccinations
5. Cosmetic procedures
6. Euthanasia or cremations
7. Dental care
8. Treatment of farm animals, animals owned by breeders, or animals used for research or commercial purposes of any kind.
9. Declawing, ear cropping, or debarking surgeries.

This is THREE of SEVEN signatures. Please sign and go onto the next page.(Required)

I have read the above information and agree to the terms of the application.

Name(Required)

First Last

RULES FOR APPLYING

* LEADSRQ sends funding directly to the treating veterinarians ONLY IF your application is approved and treatment is scheduled. No contributions are EVER given directly to individuals.
* LEADSRQ will not reimburse for “paid invoices” and will not consider reimbursement situations of any kind. If you have already paid your veterinarian for services, please seek other arrangements for assistance.
* Incomplete requests will be automatically denied, specifically, if any piece of required documentation is not included, we will not be able to assist.

This is FOUR of SEVEN signatures. Please sign and go onto the next page.(Required)

I have read the above information and agree to the terms of the application.

Name(Required)

First Last

QUESTIONS TO ANSWER BEFORE APPLYING

If you answer no to any of these questions, you will not meet the criteria for financial assistance from Lead SRQ. Do not continue with the application, and seek additional resources here instead.

Is the animal a family-owned pet?(Required)

Yes

Has the pet recently been seen by a veterinarian regarding this issue?(Required)

Yes

Has the veterinarian finished the diagnostic work (x-rays, blood work, etc.) and provided a treatment plan?(Required)

Yes

Does the pet have an immediately life-threatening injury or illness that requires urgent care within the next few days?(Required)

Yes

According to your veterinarian, is there a good prognosis for your pet with treatment?(Required)

Yes

Has the applicant applied for Care Credit or Scratch Pay?(Required)

Yes

Does the applicant have a limited income, on government assistance, or proof of financial hardship as clarified previously in the application guidelines?(Required)

Yes

APPLICATION PROCESS

Read through the guidelines. Collect all necessary documentation. If you are ready to begin the application, and believe your pet/family meets the criteria for assistance, proceed to the application on the next page.

This is FIVE of SEVEN signatures. Please sign and go onto the next page.(Required)

I have read the above information and agree to the terms of the application.

Name(Required)

First Last

Pet name(Required)

Client's Email(Required)

Client's Address(Required)

Street Address Address Line 2 City State ZIP Code

Client's Phone(Required)

Date(Required)

MM slash DD slash YYYY

Has a licensed veterinarian determined that with treatment, your pet has a good prognosis?(Required)

Yes

Diagnosis(Required)

Type of animal(Required)

Pet's breed(Required)

Pet's age(Required)

Total amount of invoice(Required)

Have you applied for Care Credit or Scratch Pay?(Required)

Yes

Were you approved?(Required)

Yes

Amount of Care Credit or Scratch Pay approved(Required)

Total amount already paid towards the cost of the current invoice for pet's treatment by the family (our assistance does not cover the cost of the exam or any diagnostics.)(Required)

How much have you secured in donations through Gofundme, friends, family, or other organizations?(Required)

Do you have veterinary insurance?(Required)

Yes

If you have veterinary insurance, what is the amount your insurance policy will reimburse?

Total LEADSRQ requested amount (not to exceed $1000)(Required)

Have you asked the hospital for a discount?(Required)

Yes

How much of a discount is the hospital willing to provide? (% or $):

Describe the medical problem and treatment:(Required)

Name of the emergency / specialty veterinary hospital where your pet is being treated:(Required)

Phone(Required)

Clinic or doctor's email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Attending Clinician’s name(Required)

Specialty:(Required)

Please check each box that applies to your current situation (if TRUE, check the box):(Required)

I am currently employed

I am currently unemployed

I receive social security or disability benefits

I receive government assistance and/or food stamps

We do not qualify for a credit card

We do not have pet insurance

My family’s household income is below the poverty level

Describe the hardship you claim:(Required)

Because our program offers financial assistance, you must disclose the combined household income of all adults. This includes those sharing a residence - whether you are in a relationship or just roommates. This is how we qualify each applicant into our various programs.

Projected household income this year?(Required)

(numbers and decimal only, add together the income for ALL adult members of your household. If you leave this blank or enter a range or any other character that is not a number, your request will be auto-denied)

Last year's household income?(Required)

(numbers and decimal only, enter the amount reported on your 2021 Tax Return for ALL adult members of your household. If you leave this blank or enter a range or any other character that is not a number, your request will be auto-denied)

Number of total people in household, including adults and children?(Required)

Number of Adults(Required)

Number of Children

Total $ monthly bills:(Required)

How long have you owned your pet?(Required)

How many dogs do you own?(Required)

How many cats do you own?(Required)

Is your pet already spayed/neutered?(Required)

Yes

My pet in need is not spayed/neutered because:

REQUIRED DOCUMENTS

All of the following documents must be uploaded and attached to this application to proceed. Applications without these documents will not be considered completed and therefore will not be processed or approved for assistance. There are no exceptions.

FINANCIAL Information

Proof of Income or Social Security/Disability(Required)

Drop files here or

Max. file size: 300 MB.

Proof of Income or Social Security/Disability(Required)

Drop files here or

Max. file size: 300 MB.

Proof of application for care credit(Required)

Drop files here or

Max. file size: 300 MB.

Documentation of payments already made to cost of care with balance needed to complete pet's treatment plan(Required)

Drop files here or

Max. file size: 300 MB.

List of resources where applicant has applied for funds (or N/A)(Required)

CLINICAL Information

Written cost estimate of treatment(Required)

Drop files here or

Max. file size: 300 MB.

Detailed statement of pet's clinical condition including your veterinarian's clinical notes explaining what treatment is needed and your pet's prognosis with treatment(Required)

Drop files here or

Max. file size: 300 MB.

If you are approved for assistance, we ask you for three things:

If you are approved for assistance, we ask you for three things: To let our donors know what their support means to your family: attach 2 photos of your pet plus a note of thanks. Describe what it means to you if you are to receive assistance from LEADSRQ. Pets helped by LEADSRQ are featured on our website and social media. Please share the link to let your friends and family know just how much LEADSRQ has meant to you and your pet. When your financial circumstances change, we hope you will “pay it forward” by helping the next family in need by donating to LEADSRQ.

Photo of your pet(Required)

Drop files here or

Max. file size: 300 MB.

Please write a thank-you note. In your own words, please let donors know what it means to you if you’re approved to receive assistance from LEADSRQ.(Required)

This is SIX of SEVEN signatures. Please sign and go onto the next page.(Required)

I agree to the terms outlined below:

I UNDERSTAND AND AGREE that, in accepting funds from LEADSRQ for my pet, I will pay an identified amount toward my pet’s treatment expenses. I understand I must pay this before LEADSRQ funds and hospital discounts will be applied in payment to my invoice. If for any reason, I do not pay my agreed-upon share of the invoice or if I default on payment as I have agreed, LEADSRQ funds and matching discounts will be withdrawn and I will be responsible for paying the entire invoice.

I have attached all of the required documentation above and agree to the terms of the application.

Name(Required)

First Last

Signature(Required)

LEAD SRQ FUNDING AGREEMENT

I UNDERSTAND AND AGREE that, in accepting funds from LEADSRQ for my pet, I will pay an identified amount toward my pet’s treatment expenses. I understand I must pay this before LEADSRQ and hospital discounts will be applied in payment to my invoice. If for any reason, I do not pay my agreed-upon share of the invoice or if I default on payment as I have agreed, LEADSRQ funds and matching discounts will be withdrawn and I will be responsible for paying the entire invoice.
I have attached all of the required documentation and agree to the terms of the application.

Name(Required)

First Last

Signature(Required)

If you have any questions about your pet’s funding, please contact LEADSRQ at leadsrq.org.

Phone

This field is for validation purposes and should be left unchanged.

Veterinary Assistance

Apply for Veterinary Assistance

LEADSRQ Application

To Begin Your Application

Before You Start

COLLECT THE FOLLOWING REQUIRED DOCUMENTATION

ELIGIBILITY GUIDELINES

WHAT WE DO NOT FUND

RULES FOR APPLYING

QUESTIONS TO ANSWER BEFORE APPLYING

APPLICATION PROCESS

REQUIRED DOCUMENTS

FINANCIAL Information

CLINICAL Information

If you are approved for assistance, we ask you for three things:

LEAD SRQ FUNDING AGREEMENT

Helping to keep pets in loving homes.