Pet & Pet Owner Assistance in Birmingham, AL

READ AND COMPLETE THE APPLICATION IN FULL. - incomplete applications will not be reviewed.

* Indicates required field

I have read the information above. I understand that I MUST fill out this application IN FULL. I understand that volunteers do NOT have the time to contact me to gather information which I failed to provide concerning myself or my pets. If you do not hear back from us in 24 - 48 hours, please resubmit your application. *

I understand that I will be responsible for contributing to my pets care. I understand a plan will be made based on needs and I will be expected to meet my obligation. Please plan to have something to pay prior to your vet visit to show your good faith. *

I understand that in order to be considered for assistance, if my pet is not fixed (spayed/neutered) that I must agree to have this procedure done. **If a pet is not able to be fixed due to medical reasons, then this will be determined by the veterinarian** *

Transportation *

I DO have transportation to get to the vet I do NOT have transportation to get to the vet I do NOT personally have transportation but am able to arrange for reliable transportation.

Name *

First

Last

Street Address. Include Apartment/lot numbers *

City and State *

Zip Code *

COUNTY (the county where I live) *

Other: ONLY IF YOU CHOSE "OTHER" from the drop box *

email address *

Phone number *

I have received assistance from Sugarbelle Foundation in the past. *

If yes, what assistance did you receive and what is the pet's name. If no, just put did not receive assistance. *

Name of Veterinarian your pet uses *

Phone number including area code of Vet office *

My pet has received the following vaccinations *

Dogs: bordetella/parvo/rabies Dog/cat: rabies only Cat: Fvrcp/rabies My pet is not vaccinated

If you answered that your pet is NOT vaccinated, please explain why here *

READ THIS CAREFULLY. YOU MUST ANSWER this correctly. If your dog is FIXED (spayed) then they cannot have puppies. They have had a surgery for this. If your dog is NEUTERED, that means they have no testicles. They cannot breed and this was done by surgery. If your pet is NOT FIXED (Spayed/neutered) that means they can breed. MAKE SURE YOU CHOOSE THE RIGHT BOX BELOW!! *

My pet is: *

Fixed (spayed) cannot breed - canNOT have puppies Fixed (neutered) cannot breed -NO testicles NOT fixed (spayed) can breed (can HAVE puppies) NOT fixed (neutered) can breed (can make puppies)

My Pet is a: *

Other: only fill out if your dog is not a cat/dog *

If your pet is NOT FIXED, please explain why. If your dog IS fixed, just put N/A *

FOR DOGS: HEARTWORM prevention is a monthly pill your pet takes as a preventative. DEWORMER is NOT the same thing. Heartworms come from your pet being bitten by a mosquito. It is EXPENSIVE to treat and without treatment, they can die. It is much less expensive to keep them on prevention. *

My dog ; *

Does NOT take heartworm prevention DOES TAKE a monthly heartworm preventative My pet is not a dog

**If your dog is NOT on Heartworm prevention, please explain WHY here: (if you have a cat, you don't need to answer) *

We need assistance with the following. Choose all that apply *

If you chose surgery, what is the estimate? please email the estimate to [email protected] *

My pet lives *

If you chose other, please explain here *

I have applied for Care Credit *

Yes. I was approved. Please list the amount below. No. Please explain in the box below

Care Credit Information - please list the amount for which you were approved or why you were denied. You may be asked to show proof of application. *

I have applied for assistance from the following groups. I was/was not granted funds. Please put N/A if this does not apply *

Please explain the reason you are needing financial assistance to help your pet. You may be asked to show proof. This is NOT what your pet needs. *

Please tell us the amount you are comfortably able to pay toward your pet's care at their appointment. We REQUIRE that pet parents contribute toward the care of their pet(s). We are happy to work with you on making payments. *

I am able to: *

****Please tell us what is currently going on with your pet that requires your pet to receive medical assistance. Please be clear in what they are needing and why. WE MUST HAVE ALL information in order to assist you. *

**Please describe the animal needing ASSISTANCE. If you have more than one pet needing assistance, please fill out their information in the last box. You may list all additional pets needing assistance in the last box. We need their NAME/AGE/COLOR/BREED/M or F *

PETS NAME *

PETS AGE *

COLOR OF MY PET *

BREED (if mixed, please list the breeds) *

My pet is *

Male Female

Color (of pet) *

PLEASE LIST ADDITIONAL PETS NEEDING ASSISTANCE: We need their NAME/AGE/COLOR/BREED/Male or Female/Fixed or not fixed and information on what they need: EXAMPLE: Fido/3 yrs/Boxer mix/ blonde/F/fixed. Fido needs to see the vet to be fixed and get vaccinated. *

You can contact us by emailing [email protected]
If needing assistance, please complete the contact form below.

READ AND COMPLETE THE APPLICATION IN FULL. - incomplete applications will not be reviewed.

Visit us on social media for more information and updates!

You can contact us by emailing [email protected] ​If needing assistance, please complete the contact form below.

READ AND COMPLETE THE APPLICATION IN FULL. - incomplete applications will not be reviewed.

Visit us on social media for more information and updates!

You can contact us by emailing [email protected]
If needing assistance, please complete the contact form below.