Application for Assistance

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Vet Tech, Aaron, helped one of our Delta Dogs clients recover from being spayed.

Delta Dogs is a non-profit, community supported organization that believes that a person’s ability to provide love and compassion to their pets is not based on their net worth. Our mission is to provide routine, basic veterinary services for pets (annual vaccines, flea/heartworm meds, spay/neuter) owned by people who live below the poverty line. We DO NOT provide emergency services for pets at this time. 

Please review our program rules before you fill out an application:

  1.  You must live within the city limits of Mobile. We currently don’t have funding to support other areas in Mobile or Baldwin County.
  2. You must agree to spay or neuter all of your pets. This is not negotiable, but we provide this as a free service.
  3. You must agree not to obtain (e.g. adopt, buy, etc.) any more pets.
  4. All pets in your home must be part of the Delta Dogs Program.
  5. We do not support any animal breeding.
  6. You must be able to provide evidence of your financial status (from your application) at your first appointment.
  7. This is not an emergency, but a request for routine care.

After you fill out an application, a Delta Dogs representative will contact you within 48 hours.

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Your Name (required)

Street Address (required)

City, State, Zip Code (required)

Phone Number (required)

Email

Date of Birth mm/dd/yr (required)

Last Four Digits of Applicant's Social Security Number (required)

Do you have transportation or can your secure transportation to veterinary appointment within the city of Mobile? Please explain. (required)

Please check all that apply so that we can determine your eligibility for care. You will be required to **provide documentation** for each checked box to enter our program.

 I am eligible for food stamps. **My income is at or below poverty level. I am eligible for Social Security or Disability. I have special circumstances.

**2016 HHS Poverty Guidelines - Annual Income
1 person in household – $11,880/year
2 people – $16,020/year
3 people – $20,160/year
4 people – $24,300/year
5 people – $28,440/year

How much do you (or your family) make in one year? Please count every person in your household. (required)

How many people are in your household? Please count every person in your household. (required)

If you checked the "special circumstances" box above, please describe your situation:

Are you Active Duty Military or are you a Veteran of the U.S. Armed Forces? Please explain.

You are a Veteran if:
1. You have engaged in active duty (including basic training) in the U.S. Armed Forces (Army, Navy, Air Force, Marines, or Coast Guard), or are a National Guard or Reserve enlistee who was called to active duty for other than state or training purposes, or were a cadet or midshipman at one of the service academies, AND 2. you were released under a condition other than dishonorable.

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Please provide information about your pet(s) and what veterinary services they need.

Pet Name

My pet is a  Cat Dog Other

What breed is your pet? Example: Siamese cat, domestic short hair cat, pit bull mix, chihuahua, rabbit, ferret, etc.

Has your pet already been spayed or neutered (i.e. altered/fixed)? Respond YES or NO.

Date your pet was spayed/neutered?

How old is your pet?

My pet needs the following veterinary care:

Has your pet been seen by a Veterinarian within the last three years? If so, please explain what treatment they had. Be prepared to bring their records to your appointment.

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Pet Name

My pet is a  Cat Dog Other

What breed is your pet? Example: Siamese cat, domestic short hair cat, pit bull mix, chihuahua, rabbit, ferret, etc.

Has your pet already been spayed or neutered (i.e. altered/fixed)? Respond YES or NO.

Date your pet was spayed/neutered?

How old is your pet?

My pet needs the following veterinary care:

Has your pet been seen by a Veterinarian within the last three years? If so, please explain what treatment they had. Be prepared to bring their records to your appointment.

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Pet Name

My pet is a  Cat Dog Other

What breed is your pet? Example: Siamese cat, domestic short hair cat, pit bull mix, chihuahua, rabbit, ferret, etc.

Has your pet already been spayed or neutered (i.e. altered/fixed)? Respond YES or NO.

Date your pet was spayed/neutered?

How old is your pet?

My pet needs the following veterinary care:

Has your pet been seen by a Veterinarian within the last three years? If so, please explain what treatment they had. Be prepared to bring their records to your appointment.

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Please add additional information to help us understand your situation. If you have more than three (3) pets, please describe those pets and their needed care here.

 By checking this box, you are certifying that all of the information supplied is correct, you *agree* to spay/neuter your pet, you live *within* the City of Mobile limits, and you can supply proof of financial eligibility.

 

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