Apply - FACE Foundation

Are you a resident of San Diego County*

Yes
No

Has your pet been seen by a veterinarian and diagnosed with an emergency condition?

Yes
No

Unfortunately FACE is not able to provide funding outside of San Diego County at this time. Please refer to our list of other resources for assistance: Resources for Veterinary Expenses.

If your pet has not been seen by a veterinarian, please refer to our list of partner veterinary hospitals, many of whom offer discounted exams: Veterinary Hospitals. If your pet is still in need of diagnostic testing, please refer to our list of other resources for assistance with those costs: Resources for Veterinary Expenses.

Request for Financial Assistance

Owner(s) First and Last Names*

Owner Email*

Address*

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

Phone*

Employer (if currently working)*

Work Phone

Pet's Name*

Pet's Sex*

Male
Female

Breed*

Spayed/Neutered?*

Yes
No

Vaccines Current*

Yes
No

Veterinary Hospital:*

Pet’s Medical Condition/Issue:*

Ownership Duration*

Pet's Birthday*

Acquired pet from:*

Pet Insurance?*

Yes
No

Policy #*

Annual Household Income*

Number of adults in household*

Number of children in household*

Monthly Rent/Mortgage*

Nature of Financial Hardship (please be specific):*

Financial Assistance (if currently receiving any)

FACE believes in “paying it forward.” What monthly donation will you pledge to help us save more pets:*

Please include photos of your pet

Drop files here or

Signature*

I declare that I have exhausted all alternative options available to me for financial assistance, however, I agree to reimburse the Foundation for any funds received upon a change in my financial circumstances. In addition, I hereby assign to the Foundation all rights to any amounts received from insurance or other source of recovery related to this matter. I do not operate any form of breeding facility for profit and agree to provide financial documents in support of this request. I agree to have my pet spayed/neutered during or after the treatment provided. I understand that the Foundation is not responsible for the treatment and/or result of any veterinary services provided and hereby waive any and all claims for liability against the Foundation, and that the Foundation hereby reserves the right to deny a Request for Financial Assistance to anyone for any reason. I understand that FACE is not financially responsible for charges incurred at the treating veterinary hospital prior to the submission of this application. I understand that if I am approved for funding, I am not automatically approved for any further assistance. I authorize the Foundation to use my and/or my pet’s photograph and any information relating to the payment of funds pursuant to this application for any purpose. I agree to volunteer for the Foundation’s special events and fundraisers. I declare, under penalty of perjury, that the foregoing is true and correct to the best of my knowledge.

Request for Financial Assistance

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