Veteran Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Alternate/Emergency Phone*

Email*

Branch of Service*

Choose One*

Active
Active Reserve
IRR
Inactive

MOS

Honorably Discharged?*

Yes
No

ETS Date*

Combat Related Diagnosis (list all):*

Have you, or are you currently, seeking treatment for the above referenced medical issues? Please describe:

Please help us understand what you feel a companion animal can bring to your life, and what you feel you can bring to their life:*

Do you feel able, ready and willing to fully care for a pet? Please elaborate:*

If accepted into the program, are you willing to allow PETS HEALING VETS to monitor you and your pet's progress, including but not limited to: scheduled home visits, phone call check-ins, vet checks?*

Yes
No

If accepted into the program, your pet will be given at no cost. However, pets require food, annual exams, occasional emergency care and other such expenses. Are you financially able to meet these requirements?*

Yes
No

Please list the names and ages of all people currently living in your home, as well as those who will frequently come in contact with your pet:*

Are all of the above aware of your desire to enter the program? Are they comfortable around animals, and are they in agreement with having a pet in your home for the life of the pet?*

Yes
No

Are you able to provide a veterinary reference? If you do not currently have a veterinarian, will you be able and willing to provide us with the contact information for a veterinarian within 72 hours of adopting your pet?*

Yes
No

Name of veterinarian:

Phone

Are you interested in a cat or dog?*

Cat
Dog
Either

Do you have any concerns as to the type/breed?*

Is there a specific type/breed you are most interested in?*

Are you willing to allow PETS HEALING VETS to make the final decision as to the pet that is best for you and your situation? We will take into serious consideration the animal in which you have an interest.*

Yes
No

Do you have any desire to adopt a special needs pet? This could be a pet with either a physical or mental/behavior issue. We will not adopt out any animal with human aggressive tendacies. If you would be interested, please explain why:

Many of our animals need to learn basic obedience. Are you able and willing to train your pet?*

Yes
No

Do you have any other pets currently living in your home, or pets that frequently visit? If yes, please provide us with the type of animal, age, breed and temperament.*

Please let us know anything else about yourself that you feel will help us determine your eligibility and to match you with the right pet.

Pets Healing Vets Program Application

Help a vet. Help a pet.

Apply for a Dog or Cat