HEART Horse assistance program – click here Request for information on assistance with food and vet careFirst name(Required) Last name(Required) Street address(Required) City(Required) Zip code(Required) Email(Required) PhoneI would like to receive information on(Required)choose onepet food availabilityveterinary careotherInformation on getting pet food.We have a limited supply of pet food on hand at the shelter. Please submit this food request and, if the pet food that you are looking for is currently available, a Pet Retention Specialist will contact you by either phone or email for a pick up date and time.Species(Required)choose onecatdogotherOther, please fill in species Food requested(Required)choose onesmall bag drylarge bag dry5 cansadmin food Resolution/foodFollow upchoose onenoyesContact agent Contact date MM slash DD slash YYYY Follow up comments Follow up notesPick up date MM slash DD slash YYYY Pick up time : Hours Minutes AM PM AM/PM Outcomecompletedreferred to other resourcesno responseno showotherCompleted food requestschoose one0 - resolved by client1234Help with veterinary care To acquire financing for pet medical needs, click a link below to go to ScratchPay a program available at six participating area veterinarians. Should you choose this option, you will not need to submit this form. ScratchPay Link Veterinary services at a discounted rate are often available through the Pet Retention office. Please click Submit below to send us a request for information. admin vet Admin vetContact agent Contact date MM slash DD slash YYYY Owner applied for financial assistancechoose onenoyesThrough what agencychoose oneScratch PayCare CreditotherApprovedchoose onenoyesDoes the owner have a vet's diagnosis?choose onenoyesSummary of diagnosis Call outcomechoose oneowner chose 300referred to other resourcesemail sent to vet staffresolved by clientrequested more informationno responseappointment madeAdmin notesAppointment Date MM slash DD slash YYYY Time : Hours Minutes AM PM AM/PM Final vet assistance request outcomechoose oneno showcancellednever submitted documentationcare completedTicket closednoyesOther servicesPlease use the space below to describe what it is you are requesting. One of our Pet retention Specialists will contact you either by phone or email to discuss your request.Please enter your request here. admin other Other resolutionContact date MM slash DD slash YYYY Contact agent Notes Other outcome CommentsThis field is for validation purposes and should be left unchanged.
