Please complete one enrollment form for each pet the client owns.

Contact Information

Drop your files here or click here to upload
Please upload a photo of client's ID card.
(First and Last)

Eligibility Verification

Examples: SNAP/EBT, Medicare, Medicaid
Drop your files here or click here to upload You can upload up to 3 files.
Please upload a photo/scan of a program ID card to another social support program for verification. Must have client's name on it.

Pet 1 Information

For cats, just enter "cat"
Drop your files here or click here to upload
Please upload a photo of your pet.
Drop your files here or click here to upload You can upload up to 5 files.
Please upload any recent veterinary records you have.

Pet 2 Information

For cats, please just enter "cat"
Drop your files here or click here to upload
Please upload a photo of your pet.
Drop your files here or click here to upload You can upload up to 5 files.
Please upload any recent veterinary records you have.

Enrollment Review Policy

All enrollment requests will be reviewed within five business days. The case manager identified in this form will be notified via e-mail of results.